Guest guest Posted October 16, 2001 Report Share Posted October 16, 2001 Join my confusion... BPD is the first surgery LISTED with Health Net. However, my Medical Group refused it... and so Health Net ALSO refused it. The problem is... my Medical Group only contracts with UCLA. UCLA does not do the BPD/DS procedure. Thus, they have an automatic refusal. Elle <To: <duodenalswitch > Subject: DS and BPD and insurance > To Elle and because I'm confused myself... > In Elle's e-mail she mentions that the BPD is her insurance provider's top choice, and that they won't cover the DS. > Seems to me that these procedures are very similar, as least " on the face of it " . > Here's a link to the American Society of Bariatric Surgery's web site that describes the two... > > http://www.asbs.org/html/story/ch_3.html > > It seems that the difference is basically that the stomach part is less " radical " with the DS. Maybe the difference is something of a semantic issue, such that her doctor could describe the DS procedure as a " Biliopancreatic Diversion with Vertical Gastrectomy " , or the like, to get the coverage through? > > --Randy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 16, 2001 Report Share Posted October 16, 2001 Ellen, Was i confused in understanding that your insurance only allows one appeal and that you telephoned them, so they considered that your one appeal? I do believe they are " dicking " you around. I think you could probably contact the insurance oversite board in California and make them at least consider an " official " appeal. Hopefully, Hull might be able to shed some light on this for you. Hugs and prayers, Theresa > Join my confusion... BPD is the first surgery LISTED with Health Net. > However, my Medical Group refused it... and so Health Net ALSO refused it. > The problem is... my Medical Group only contracts with UCLA. UCLA does not > do the BPD/DS procedure. Thus, they have an automatic refusal. > > Elle > > > From: " Randall Long " <rlong@i...> > <To: <duodenalswitch@y...> > Subject: DS and BPD and insurance > > > > To Elle and because I'm confused myself... > > In Elle's e-mail she mentions that the BPD is her insurance provider's top > choice, and that they won't cover the DS. > > Seems to me that these procedures are very similar, as least " on the face > of it " . > > Here's a link to the American Society of Bariatric Surgery's web site that > describes the two... > > > > http://www.asbs.org/html/story/ch_3.html > > > > It seems that the difference is basically that the stomach part is less > " radical " with the DS. Maybe the difference is something of a semantic > issue, such that her doctor could describe the DS procedure as a > " Biliopancreatic Diversion with Vertical Gastrectomy " , or the like, to get > the coverage through? > > > > --Randy Quote Link to comment Share on other sites More sharing options...
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