DS doctors with support staff who know how to fight insurance!

  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.

My insurance (BCBS MA) 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!!!!

There are quite a few people on the DS board who have revised to DS from other surgeries, and are quite informed about this.

I'd re post your question on the DS board to make sure they see it. Good luck!

As I have found out, because I just fought BCBS in the same situation, the government requires BCBS to cover the DS for it's medicare participants. Anything coming straight from the insurance company is not under the same guidelines.

Dr. Inman in the Carmel St. Vincent Bariatric Hospital Is the only doctor there that does DS surgeries in Indiana. She did both my husbands and mine. Both were awesome. She is amazing!  Call 317-582-7088 and tell them you want to set up a consultation for the Duodenal Switch surgery with Dr. Inman. After you go to that and are wanting surgery through insurance, Dr. Inman's office will help you do that. Their phone number is 317-814-4580. You have to call the bariatric center first, the 582 number to get things rolling and set up the consultation, after that Dr. Inman's office will help ya!!!! SHe does revisions and is amazing at them. She is located in Carmel Indiana, just outside of Indianapolis, Indiana. I'm not sure where you are coming from. Just thought I would post this for ya!

That's not far at all.  I'll be coming from Chicago.  Thank you so much for caring enough to answer my question.  I'll be making some calls!