Best DS doctors with support staff who will fight insurance for you!!

  I'm seeking a revision from RNY to DS but I'm worried about my insurance.  I want to go with the best doctor as well as the best office that will support my journey.  Therefore......I'd really be interested in hearing from you guys which Dr's office you believe was the best in going to bat for you to fight insurance denials.  Or which office you think prepared the best prior to submitting your information for insurance in order to lessen the chance of a denial.  This is inside or outside Illinois.  I will travel!

My insurance (BCBS MA.  Employer is based in Massachussets but I live in Illinois) covers weightloss surgery but will only cover DS in specific situations  This is exactly what it says:

"We cover the following surigal procedure For Medicare HMO, Medicare PPO Blus and Blue Medicare PFFS Plus RX members only in accordance with centers fo Medicare and Medicaid services : Biliopancreatic diversion with duodenal switch-open and laprascopic"
 
Further down it states-The following will reject as non-covered leaving no patient balance as these procedures do not meet our medical technology assessment guidelines:
 
CPT 43845 (covered for Medicare HMOB, Medicare PPO Blue and Blue Medicare PFFS Plus Rx only)
 
This is odd to me.  How does it not meet the guideline yet  they cover it for a certain sector?  Is this a loophole that can be used?

Please help.  I am ready to fight!!!!

I have BSBS NY, I work for a NY company but live in Illinois and they paid for my lap band.  I really think it is what the company will pay for.

I know there is a insurance lady on the lap band board, she helps out a lot of people.  I don't know her name, but if you post something about insurance she will replay.

Good luck,
Don't give up!

Lynne

*HIJACK*
Hey Lynne

How are you doing?

HEY how are you doing?  I left you a message awhile ago on your page, when you changed your name?  How did your surgery go?  How have you been?

Lynne
I still have the same phone number if you want to chat.

Send me your number.....

I have BCBS Anthem, based in Ohio, and what I did was called their bariactric dept and asked to be sent all info regarding the program. Including what hospitals and what doctors I could use. Also, it doesn't matter where your BCBS is based, it will eventually end up in BCBS Illinois. I had no problems at all with theem, and approval was within 10 days. I did have lapband, not a ds, but by playing thier game it was easy.


BTW, the gal on the lapband forum that helps with the insurance is Vicki.

Good Luck.

Lisa

Hi, Ada! Not too many DSers on the Illinois board. I saw that you already posted this on the DS board and got a response from the best insurance fighter we've got there--Diana Cox. I would sit at her feet and learn. LOL. You can start by sending her a PM and ask specifically how she thinks you should proceed.

Also, her surgeon (and mine) is John Rabkin, one of the best at RNY to DS revisions. He takes on a lot of tough cases with success. I highly recommend him!

His office is knowledgeable and terrific, but not sure how capable at fighting insurance they can be in this type of case.

Dr. Rabkin is based in San Fran, but he comes to Chicago almost monthly for our support group meeting, as he has lots of patients here. He was just here on Monday and will have to miss the February meeting. He will be here for the March meeting, on the third Monday, fro 6-8 p.m. at 65 W. Jackson, 8th floor. Don't know if you are in the Chicago area or not, but I'd be willing to meet you for coffee (or a juicy steak--LOL) anytime.

Feel free to PM me for any specific questions o read my profile. And keep posting your questions on the DS board--like me, those folks are excited to help "pay it forward" and educate people about this this little-known, life-changing WLS option.

Good luck to you!

Nicolle
For more info, visit www.dsfacts.com

Hi Nicolle,

How kind you are to extend your hand to me.  I would definitley like to take you up on the offer of coffee on the day of the next meeting.  I live in the Northwest suburbs but I'm used to driving to Chicago.  What's parking like in that area?  I definitely want to go to the meeting.  Doesn't Dr. Rabkin charge a fee upfront?  Please enlighten me?

Hi Lynne,

Thank you for telling me about Vicki for fighting insurance.  That gives me a starting point!

Lisa, that is interesting...You mean at the end of the day BCBS (IL) may be the deciding factor in my coverage.  Wow.  These guys are powerful.

I'm gonna get started by arming my self with knowledge.    Thanks guys for pointing me down a path!

hi i had a friend visit a surgeon in skokie illinois she has insurance. she had the gastric bypass 6 years ago and want to get a revision to the ds. he told her he would say she's having surgery for a hernia if thats what it takes to get her insurance to aprove her but she still needs to call care credit and see if she can get a loan just in case she's not approved. i told her why get a loan most of the doctors overcharge the insurance companies anyway. i want to have a revison but i have medicaid and i dont know of a good doctor in illinois that will take it and do a good job on me. i have good credit but with the economy today i may not get approved. so maybe you can look up the doctors in skokie that can do a revision and you might get lucky. it's a known fact  its the way they write it up in order to get approved through most insurances anyway.