Guest guest Posted September 28, 2001 Report Share Posted September 28, 2001 I am trying to get approval from Health Net (California) for a DS surgery; however, they say that the DS is an " experimental " surgery. If you have specific information (like a research paper published in a medical journal) which would support my position with Health Net, please send me info on where I can obtain it. Or... better yet, if Health Net PAID for your surgery, please let me know. I know they have paid for some people for the DS surgery... and I am trying to gather some backup that they have already paid for this surgery. I believe it is about money, rather than that they are thinking of my health Thank you in advance... Elle Rowley Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2001 Report Share Posted September 29, 2001 Take heart, Elle. United healthcare did the exact same thing to me.. and I did prove historical precedence. Your on the right track.. good luck! > I am trying to get approval from Health Net (California) for a DS > surgery; however, they say that the DS is an " experimental " surgery. > If you have specific information (like a research paper published in > a medical journal) which would support my position with Health Net, > please send me info on where I can obtain it. Or... better yet, if > Health Net PAID for your surgery, please let me know. I know they > have paid for some people for the DS surgery... and I am trying to > gather some backup that they have already paid for this surgery. I > believe it is about money, rather than that they are thinking of my > health Thank you in advance... Elle Rowley Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2001 Report Share Posted September 29, 2001 HI Elle, You might also consider the fact that medicare pays for the DS and if they pay for it its not considered experimental!! Medicare has paid for many DS surgeries! Hugs, Judie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2001 Report Share Posted September 29, 2001 Hi Elle, I just reponded to your post in DS_Insurance_Authorization before I saw this one. Regarding the DS being " experimental " or " investigational " , I have devoted the better part of the last three months doing research that debunks this myth. You will find it on : http://groups.yahoo.com/group/duodenalswitch/files/ go to " Hull's folder " and look at the file: aetna letter.doc 51 journal papers are referenced, and I have copies of about 30 of them (the others I had the abstracts only). Hull > I am trying to get approval from Health Net (California) for a DS > surgery; however, they say that the DS is an " experimental " surgery. > If you have specific information (like a research paper published in > a medical journal) which would support my position with Health Net, > please send me info on where I can obtain it. Or... better yet, if > Health Net PAID for your surgery, please let me know. I know they > have paid for some people for the DS surgery... and I am trying to > gather some backup that they have already paid for this surgery. I > believe it is about money, rather than that they are thinking of my > health Thank you in advance... Elle Rowley Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2001 Report Share Posted September 29, 2001 Thank you for all of your messages. I have a lot of homework to do in my quest for a second review of my case with Health Net. I weigh 369 lbs at 5'1 1/2 " with a BMI that I calculate in the mid 60's (although my physician says it is only 53...which would be at least slightly better if he is correct.) My goal in having the DS is that I want to lose adequate weight... and once having lost it, to keep it off. I also don't want the " dumping " syndrome... and I want to live as near a normal life as possible with my friends and family (like eating a near-normal meal). My Dr. is supportive of the DS procedure, but his Medical group is not... and neither is Health Net. They insist that the only course of action for me is an RNY. I have been told verbally by Health Net that I only have one appeal process left... which is to a committee called the DMHC? Anyway, I want to have my ducks in a row with this appeal. Elle Rowley Re: Insurance approval for DS > Hi Elle, > > I just reponded to your post in DS_Insurance_Authorization before I > saw this one. > > Regarding the DS being " experimental " or " investigational " , I have > devoted the better part of the last three months doing research that > debunks this myth. You will find it on : > > http://groups.yahoo.com/group/duodenalswitch/files/ > > go to " Hull's folder " > > and look at the file: aetna letter.doc > > 51 journal papers are referenced, and I have copies of about 30 of > them (the others I had the abstracts only). > > Hull > > > > > I am trying to get approval from Health Net (California) for a DS > > surgery; however, they say that the DS is an " experimental " > surgery. > > If you have specific information (like a research paper published > in > > a medical journal) which would support my position with Health Net, > > please send me info on where I can obtain it. Or... better yet, if > > Health Net PAID for your surgery, please let me know. I know they > > have paid for some people for the DS surgery... and I am trying to > > gather some backup that they have already paid for this surgery. I > > believe it is about money, rather than that they are thinking of my > > health Thank you in advance... Elle Rowley > > > ---------------------------------------------------------------------- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2001 Report Share Posted September 29, 2001 If you go to the duodenalswitch.com site and click on links you can find a link to a BMI calculator. Not sure how your physician tried to figure it but he's way off the mark. I was a BMI of about 53 at 330 lbs and 5'6 1/2 " . I work for a division of Mayo Clinic and was told my surgery would be denied as investigational. Just a little while before my surgeon's pre-cert request hit the insurance approval desk Mayo Clinic (Rochester, MN only) started doing the DS. Suddenly it wasn't investigational anymore!! It's amazing how perspective can change. Good luck, Page > Thank you for all of your messages. I have a lot of homework to do in my > quest for a second review of my case with Health Net. > > I weigh 369 lbs at 5'1 1/2 " with a BMI that I calculate in the mid 60's > (although my physician says it is only 53...which would be at least slightly > better if he is correct.) My goal in having the DS is that I want to lose > adequate weight... and once having lost it, to keep it off. I also don't > want the " dumping " syndrome... and I want to live as near a normal life as > possible with my friends and family (like eating a near-normal meal). > > My Dr. is supportive of the DS procedure, but his Medical group is not... > and neither is Health Net. They insist that the only course of action for > me is an RNY. I have been told verbally by Health Net that I only have one > appeal process left... which is to a committee called the DMHC? Anyway, I > want to have my ducks in a row with this appeal. > > Elle Rowley Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2001 Report Share Posted September 29, 2001 Congrats to you! I went to the Mayo Clinic site, hoping they would have something written about the DS. Nope. They do have a 1999 article about WLS, though. Here is the URL: http://www.mayoclinic.com/home?id=HQ01465 wrote: I work for a division of Mayo Clinic and was told my surgery would be denied as investigational. Just a little while before my surgeon's pre-cert request hit the insurance approval desk Mayo Clinic (Rochester, MN only) started doing the DS. Suddenly it wasn't investigational anymore!! It's amazing how perspective can change. ===== Dee Waiting for Ins. Co. Approval 313/Want to be 165 __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2001 Report Share Posted September 29, 2001 The Rochester clinic just began performing the DS in May. I'm surprised they haven't updated the website with the info. I'm not sure of the surgeon's name. I'd already made my arrangements with Dr. Kim and had a confirmed date, so I just ate the out of network out-of- pocket expenses. I work at for the clinic location in ville, FL. The sdale, AZ location had a surgeon who performed the RNY but he left at the end of 2000. > I work for a division of Mayo Clinic and was told my > surgery would be denied as investigational. Just a > little while before my surgeon's pre-cert request hit > the insurance approval desk Mayo Clinic (Rochester, MN > only) started doing the DS. Suddenly it wasn't > investigational anymore!! It's amazing how perspective > can change. > > ===== > Dee > Waiting for Ins. Co. Approval > 313/Want to be 165 > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
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