Need DS vs RNY docs for ins...

[Guest guest]

Hi all!

I am starting to pull together info/ammo for my second appeal. I was

not necessarily denied wls, but rather the request to receive this

medical attention out of network. We have in network surgeons that

perform the RNY, so Cigna states they do not see the medical

necessity of out my going out-of-network. So, it seems I need to

find a way to show them that, for me, the BPD/DS is the only logical

choice of surgeries.

I quality (more than qualify) for the medical necessity piece. What

I would like to have would be documents, or pieces of documents that

support the DS being superior. I've looked at the docs on the

duodenalswitch zone, and they're absolutely wonderful, but I couldn't

really find a medical arguement (detailed) as to what makes the DS a

more desireable option.

If you have info/links where I can go to get this specific

information, pleae let me know as I need to get this done ASAP )

Thanks in advance,

Donna

[Guest guest]

Check out (research expert) Hull's folder in the files section

or copy this link.

http://groups.yahoo.com/group/duodenalswitch/files/Chris%20Hull%27s%

20Folder/

Sue McN.

Vancouver, BC

> Hi all!

>

> I am starting to pull together info/ammo for my second appeal. I

was

> not necessarily denied wls, but rather the request to receive this

> medical attention out of network. We have in network surgeons that

> perform the RNY, so Cigna states they do not see the medical

> necessity of out my going out-of-network. So, it seems I need to

> find a way to show them that, for me, the BPD/DS is the only

logical

> choice of surgeries.

>

> I quality (more than qualify) for the medical necessity piece.

What

> I would like to have would be documents, or pieces of documents

that

> support the DS being superior. I've looked at the docs on the

> duodenalswitch zone, and they're absolutely wonderful, but I

couldn't

> really find a medical arguement (detailed) as to what makes the DS

a

> more desireable option.

>

> If you have info/links where I can go to get this specific

> information, pleae let me know as I need to get this done ASAP )

>

> Thanks in advance,

> Donna

[Guest guest]

Donna,

I also had to show this. I used the long term

weight loss, showed the weight regain of the RNY VS.

DS , Since I have mild reflux and my history of nausea

and vomiting easily since this is a big side effect of

the RNY, the dumping and lack of medication absorbtion

and need for liquid meds and since I am on HRT's and

thyroid, not sure if they even come in liquid form and

the need for constant monitoring of blood levels of

these drugs because of a lack of breakdown in the

stomach. And the finally was a letter from my PCP

stating my need of the DS vs. the BPD I am not sure

what all she said but she did include about the long

term medication needs, my history of vomiting very

easily and the long term weight loss versus the weight

regain know with the RNY. I sure hope this helps.

=====

B 36yrs

Pre-op 11-13-01

BMI 49

BCBS of MI Blue Choice POS

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