Re: Does this mean Aetna will no longer provide coverage for the DS?

[Guest guest]

Aetna officially will not cover the DS. However, they will cover

the " distal gasric bypass " . Technically the DS does not involve a

gastric bypass at all, so the term " distal gastric bypass " is not

quite accurate. However, the malabsorptive effect of the two

procedures is identical. There is no CPT code for the DS, so

surgeons use a combination of CPT codes. The CPT code used are:

43847

Gastric restrictive procedure; with small bowel reconstruction to

limit absorption

43633

Gastrectomy, partial, distal; with gastroduodenostomy;

with Roux-en-Y reconstruction

In my case Aetna approved code 43847 but denied code 43633. In

addition, Aetna denied the J-tube inseration and the appendix removal.

I am appealing, but if I lose then my out-of-pocket for everything

will be $4800.

My surgeon is Dr. Anthone.

For more info join the list:

DS-Insurance_Authorization_Problems

Hull