Hoping to become a DS-er. Denied by Aetna

I asked Dr. Guske about his experience.  He has done 10 RNY to DS revisions and 50 virgin DS cases.  I went through the list of "other" surgeries with him to clarify and he assured me it was an RNY-to-DS conversion (not sleeve, not ERNY, etc.).  This is very important to me.  I would, of course, wish he was one of the handful of docs on the preferred list for this revision, but he's not and none on the list are in Chicago.  I've looked into traveling, but I can't see that it's a viable option for me now.

Thanks,

Jeannie

If your self-insured plan is insisting that bariatric surgery is not covered, I would want to know exactly what kinds of "medically necessary charges for morbid obesity" would be covered.  I've worked with health insurance (both provider and insurer side) for almost 20 years and those kinds of vague statements can be challenged successfully if you put the effort into making the insurer/employer back up their exclusions list.  Make the insurer supply you with the information, in writing, from the summary plan description or their medical policy documents that states WLS is not covered.  If you work with your husband's employer, bring them to understand that their exclusions list is non-specific, and support your case with proof of medical necessity, they have the capability of overriding the denial.

Good luck!

Kristen