DS Investigational
Datrace, you may have better luck just continuing to post DS questions on the DS board. You can hear crickets chirping here. I am NOT kidding when I say I am the only DSer actively posting here. They hang out on the DS forum.
As you have no doubt read from all of us on the DS board by now, MANY insurance companies, including Aetna, now cover the DS. Once the federal government started covering it via Medicare 3 years ago, lots of insurance companies rolled over and said "yes" because the writing is on the wall.
For the education of all here, the fight usually goes this way:
1) You get your insurance company to agree that you need weight loss surgery. You are fat enough, sick enough, etc. They approve you for the cheaper ones they do, usually bands or RNY.
2) You appeal their decision, using the resources (letters, peer-reviewed medical journal articles, etc.) given to you by the folks on the DS board (one of whom is a biotech attorney and another a general surgeon, both of whom had the DS years ago).
3) In your appeal to the insurance company, you outline how the DS specifically would better help address your health issues. For example, the DS has the best CURE rate for diabetes (98.9% versus 70% for the RNY). You tell them about the health issues you have that would make taking NSAIDS a part of your life-long treatment (such as artthritis, etc.). People with RNY are NOT supposed to take NSAIDS because of marginal ulcers, which can be fatal. To give you another surgery would be criminal, when the evidence is there that there is a better option available, is your reasoning.
4) You wait. The insurance company needs to respond to you, by law, within a certain time frame.
5) If denied, then you go to the next level--an independent review by the state's insurance oversight arm.
6) You get your DS and live happily ever after. LOL.
Simple, right? Yeah, sure. But we have had people win against BCBS recently, including the one I told you about, Earthy_Mami. It's only a matter of time until the insurance companies have to capitulate and cover the DS across the board. For now, they do not want to pay for it because they cannot strong-arm the few DS surgeons out there into accepting their crappy in-network payments.
The truth is, it could be a fight, but it is a fight worth having because this is your life. And your QUALITY of life we are talking about.
For newbies who want more info on the DS, please visit www.dsfacts.com.
Nicolle
As you have no doubt read from all of us on the DS board by now, MANY insurance companies, including Aetna, now cover the DS. Once the federal government started covering it via Medicare 3 years ago, lots of insurance companies rolled over and said "yes" because the writing is on the wall.
For the education of all here, the fight usually goes this way:
1) You get your insurance company to agree that you need weight loss surgery. You are fat enough, sick enough, etc. They approve you for the cheaper ones they do, usually bands or RNY.
2) You appeal their decision, using the resources (letters, peer-reviewed medical journal articles, etc.) given to you by the folks on the DS board (one of whom is a biotech attorney and another a general surgeon, both of whom had the DS years ago).
3) In your appeal to the insurance company, you outline how the DS specifically would better help address your health issues. For example, the DS has the best CURE rate for diabetes (98.9% versus 70% for the RNY). You tell them about the health issues you have that would make taking NSAIDS a part of your life-long treatment (such as artthritis, etc.). People with RNY are NOT supposed to take NSAIDS because of marginal ulcers, which can be fatal. To give you another surgery would be criminal, when the evidence is there that there is a better option available, is your reasoning.
4) You wait. The insurance company needs to respond to you, by law, within a certain time frame.
5) If denied, then you go to the next level--an independent review by the state's insurance oversight arm.
6) You get your DS and live happily ever after. LOL.
Simple, right? Yeah, sure. But we have had people win against BCBS recently, including the one I told you about, Earthy_Mami. It's only a matter of time until the insurance companies have to capitulate and cover the DS across the board. For now, they do not want to pay for it because they cannot strong-arm the few DS surgeons out there into accepting their crappy in-network payments.
The truth is, it could be a fight, but it is a fight worth having because this is your life. And your QUALITY of life we are talking about.
For newbies who want more info on the DS, please visit www.dsfacts.com.
Nicolle
I had the kick-butt duodenal switch (DS)!
HW: 344 lbs CW: 150 lbs
Type 2 diabetes and sleep apnea GONE!
I agree that those who have bad reuslts with ALL weight loss surgeries tend to "fall off the boards." That, or they head over to the "Failed Weight Loss Surgery" or "Revisions" boards.
Interesting stories over on those forums. Lots of people trying to revise to the DS, which is an extremely complicated revision surgery.
Nicolle
Interesting stories over on those forums. Lots of people trying to revise to the DS, which is an extremely complicated revision surgery.
Nicolle
I had the kick-butt duodenal switch (DS)!
HW: 344 lbs CW: 150 lbs
Type 2 diabetes and sleep apnea GONE!
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