Bushwald, MN Cash
Does your insurance not cover the DS? If your insurance does, and you were denied FIGHT, FIGHT, FIGHT!!!!!!!!!!!!!!!!! Go over to Proboards (http://weightlosssurgery.proboards.com/index.cgi?board=talk&field=ordertime&order=desc&page=1) and ask for Diana Cox. She ans Larra helped me WIN with my insurane company, appeal, after appeal was denied, and I was at the hearing level, and WON!!!!!!!!!!!!!! Do Not Give UP!!!! That is EXACTLY what the insurance company wants!!!!!
Have you looked at DSFacts.com?
RNY 2/26/2002 DS 12/29/2011
HW 317 SW 263 BMI 45.1
SW 298 CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003
Normal BMI 24.8 is my GOAL!!!
GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**
I work for a large clinic that has their own private insurance and only covers surgeries done in house. They cover the RNY with a BMI of 40 and the DS with a BMI of 50 or a BMI of 45 with 2 comorbitidies. I was denied for the DS 4 years ago based on my BMI of 42 at the time with no comorbidities. I do not want the RNY because I have alot of headaches and need NSAIDS, also I prefer the DS anatomy vs. the RNY anatomy, so I didn't have surgery years ago. I did appeal back then and was denied again. I was just curious what self pay would be if I stayed local?
Fast forward to today. My BMI is 47 and I am getting my blood work done in a week to see if I have 2 comorbities now. It sucks, that I am hoping to flunk my bloodtest.
Fast forward to today. My BMI is 47 and I am getting my blood work done in a week to see if I have 2 comorbities now. It sucks, that I am hoping to flunk my bloodtest.
You sound like you really know your stuff and I see you have been a member here for years. I thought I'd just throw this out, possibly for other readers in need of comorbidities to qualify -- definitely get tested for sleep apnea. Many of the people seeking WLS end up testing positive for it. If you tested negative for it years ago, it may give a new result now. Perhaps x-rays (or some other scan?) could find some osteoarthritis? I hope your labs give you what you need to get the DS. It seems like you are so close now (to not having to self-pay).
Sorry I don't know the answer to your main question.
Edited to add: PCOS may be able to count for some people.
Sorry I don't know the answer to your main question.
Edited to add: PCOS may be able to count for some people.
It shouldn't be hard to get the comorbidities, I am sure you would have some degree of sleep apnea and you could complain about back pain and shortness of breath, these are hard to disprove. You are so close to the requirements that if you could get these complaints you should be alright. I would definately stick with Mayo, my wife wouldn't let me go anywhere else and Kendrick was excellent.
I was tested for sleep apnea and didn't have it. I have knees that click, but the xrays came back fine.
Odd thing is I've been eating horrible for the last 3 weeks to get my blood test to fail and lost 5 pounds so far eating crappy. My blood numbers in 2011 were borderline and I want to make sure they stay are higher for next weeks blood draw.
Odd thing is I've been eating horrible for the last 3 weeks to get my blood test to fail and lost 5 pounds so far eating crappy. My blood numbers in 2011 were borderline and I want to make sure they stay are higher for next weeks blood draw.
The DS is worth the wait, but my mom had to settle for the RNY as she has TRICARE. She has done just as well as I have. She has a little more restrictions to what she eats but has no complaints. What about VSG, will they cover that, then when healed go and get the rest of the DS by self pay, might save some $$
Glad you all have insurance that will even hear appeals or even first reqeusts I have coventry and they have a strict exclusionary policy for any WLS orheath and wellness program. Just hung up on my Surgeon when he asked for a peer to peer. I am full self pay. Anyone have further information on cost around the US for the DS or DS revision VSG to full DS??. This hospital I am dealing with will consider lessening the price If I can document a lower price at a Bariaric Center of Excelleance program in the US. Maja in St Louis, MO
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