Cindy/DS my preferred WLS

[Guest guest]

Hi Cindy,

Many people have traveled out-of-state to get their DS surgery. Many

times insurance does cover it. Sometimes there are extra hoops to

jump through to get them to approve you going out-of-network or out

of state. Sometimes it is a downright fight to get it covered; but a

fight well worth it. And many people HAVE won this fight, myself

included.

Do not consider " settling " for a surgery you do not feel is best for

you because some insurance bureaucrat tells you " you can't do that " .

The Roux-en-Y and the BPD/DS are **NOT** created equally. Your

research has shown you that the DS offers a tremendously *better*

quality of life afterwards. YOUR life, not the doctor's and NOT the

insurance company's.

Why are there not more surgeons performing the BPD/DS? Because it

takes a level of skill and expertise many surgeons are not willing or

able to achieve. Because the RNY is a " quicker " surgery that pays

virtually the same as the DS. The doctors who are offering the

BPD/DS are many times the very best surgeons around.

Visit the www.duodenalswitch.com website and look at the listing of

surgeons who do the BPD/DS. First check each surgeon to see if they

are on the " participating " list for your insurance. Even if there

are none participating, choose 1 or 2 or 3 who are a relatively easy

travel and come back here and read the archives about patients

experiences with these surgeons. Ask questions and more questions.

When you feel comfortable with a surgeons qualifications, make a

consultation appointment. The surgeon's office will contact your

insurance with documentation for pre-approval.

When you make your appointment for consultation, ask what pre-op

tests are required (usually thyroid bloodwork, gastric endoscopy,

psych evaluation, sometimes a sleep study). Get your PCP to give you

a referral to have these done locally while you are waiting for your

consult date to arrive. Bring the results of this pre-op work with

you to your consult. After your consult you may have to have

additional pre-op tests done. You can usually have these done

locally too.

After your consultation, when your surgeons office has the results of

all your pre-op work, they will submit a letter of medical necessity

(LOMN) to your insurance and then you will have to wait to see if you

are approved. You may get denied (as I did) because insurance says

you can get a " gastric bypass " IN-network.

You can appeal and win. I uploaded (to the files section of this

list) copies of letters I used (from my doctors) to win my appeal.

Alternately, there is an attorney (Walter Lindstrom) who specializes

in winning appeals for weight loss surgery patients for a very

reasonable charge. But you have to contact him early in the appeals

process if he is to have a good chance.

So, you have a very exciting journey ahead of you. Unfortunately,

there is usually more to battle than fat. But, with persevereance

and the conviction that this is the right thing for you to do, the

battle can be won; figuratively and literally. I wish you all the

best!

Terri Hassiak

BMI 61.8

http://www.obesityhelp.com/morbidobesity/profile.phtml?N=H980366398

Appealed " Out-of-Network " Ins. Denial - AND WON!!!

Laparoscopic BPD/DS with Dr. Pomp on 6/25/01 - Down 65lbs in 10 wks!

email(no spaces): bunsofluff @ hotmail.com

> Hi everyone! I've been researching long & hard and feel certain the

> DS is the type of surgery I prefer. Now I can't find a surgeon in

> Dallas, Texas that performs it! Why are there so few? Anyone have

> suggestions? If I can't locate a surgeon in Dallas ( and accepts

> Aetna HMO ) then I'll have to go ahead with the RYN and I really

> don't want to go that tiny pouch and dumping. Oh dear. I'll be

> watching for replies. Thanks a bunch!! Cindy