RE: Chris's draft response to Aetna

[Guest guest]

Very well done Chris!

The only thing that strikes me, after reading Aetna's policy statement three times, is that they do NOT mention the DS by name in their explanations. They go on at length about the Scopinaro BPD, the distal RNY, and generic gastric bypass. However, the words Duodenal Switch do not appear (other than on the list of exclusions).

I would love to know what they have to say specifically about the DS, given all of the recent data supporting it's safety and effectiveness. They don't seem to want to even acknowledge it's existence. I myself was denied by Aetna when the words "duodenal switch" appeared in my PCP's LOMN. When my surgeon called in to appeal, they approved it as long as all parties agreed to call it a gastric bypass -which, technically, it is. He just wasn't supposed to say which gastric bypass it was. If you read between the lines of the paragraph of the policy statement that goes on about moving the Roux n y connection to a more distal location, you could figure the DS would fit in there, I guess. It's all very strange.

I hope that your letter will have an impact on Aetna. How long can they get away with ignoring facts and citing ten year old data?

from NE Philly, age 39Open DS w/ Dr. Pomp, 6/27/01 w/ a BMI of 63

20 lbs gone and seeming to plateau already, dangit!

[Guest guest]

Very well done Chris!

The only thing that strikes me, after reading Aetna's policy statement three times, is that they do NOT mention the DS by name in their explanations. They go on at length about the Scopinaro BPD, the distal RNY, and generic gastric bypass. However, the words Duodenal Switch do not appear (other than on the list of exclusions).

I would love to know what they have to say specifically about the DS, given all of the recent data supporting it's safety and effectiveness. They don't seem to want to even acknowledge it's existence. I myself was denied by Aetna when the words "duodenal switch" appeared in my PCP's LOMN. When my surgeon called in to appeal, they approved it as long as all parties agreed to call it a gastric bypass -which, technically, it is. He just wasn't supposed to say which gastric bypass it was. If you read between the lines of the paragraph of the policy statement that goes on about moving the Roux n y connection to a more distal location, you could figure the DS would fit in there, I guess. It's all very strange.

I hope that your letter will have an impact on Aetna. How long can they get away with ignoring facts and citing ten year old data?

from NE Philly, age 39Open DS w/ Dr. Pomp, 6/27/01 w/ a BMI of 63

20 lbs gone and seeming to plateau already, dangit!