question about switching procedures and approval

Hi ya-all!
Okay, so I orginally went for the RNY and got denied about 6 month ago due to lack of supervised diet.

Now, I have just finished my 6-month diet and I submitted my paperwork to my doc who is to conduct the RNY.  HOWEVER, I have been reserching the Duodenal Switch surgery and have made an appointment with that doctor back in September for November 3rd. 

My questions is, will this negatively impact me if my paper work is submitted and approved for RNY and then I meet with the DS doctor and change my mind and go for the DS????

Thanks -
Iman

A lot of insruance plans do not cover DS, however if yours is one that does the I would think the medical policy for both procedues should be the same so it should not be a problem to get approval. You should be able to call customer service to see if DS is covered and if so if they medical policy is differnet.

If  your insurance doesn't have an exclusion for WLS and will cover the RNY then they have to cover the DS. They may not want to cover the DS and may have some bullcrap in their policy about  you having to have a BMI > 50 and all that bs but you can fight your insurance and win. It probably is in your best interest to be approved for RNY first, so that you can establish that you qualify for WLS, then once you get approved for RNY have your doctor resubmit asking for the DS. Do you have a HMO or a PPO? If you have a PPO then getting approved for the DS will probably be a whole lot easier.

Make sure the WL surgeon you go to is really a DS surgeon, otherwise they will not recommend that you need the DS because they don't do it. Check out www.duodenalswitch.com for an accurate list of DS surgeons in your area. Check out the DS board, there are alot of knowledgeable people on there who are more than willing to help you get approved for the DS. Good luck

This is incorrect. Plans will go by their medical policy, if they cover RNY they do not have to cover DS. I just don't want you getting your hopes up for something that may not happen. You need to request a copy or look online for your plans medical policy. Now if they policy does not specifically state DS is not covered you will have a much better chance at getting approval.

MANY patients whose insurance policies say they do not cover the DS have fought and got them to cover the DS instead of RNY. There are only a handful of insurance ocmpanies who will not cover the DS. Now that Medicare covers the DS and there is long-term DS data and proof that it is NOT to be reserved ony for the SMO, insurance that covers RNY will cover DS on appeal even if they say they won't in their policy. Yes, it will get denied initially, but it will often get approved on appeal. If you live in California, especially, the DHMC will almost ALWAYS force insurance to cover the DS if you qualify for the RNY.

Again, there are a few stubborn insurance companies who will not budge on the DS, but most can be convinced to cover it (assuming WLS in general is not an exclusion) if you are willing to fight through the appeals process.

 I know of many people who were denied by their insurance for the DS and fought and won. I will be one of those people who will not give up and my insurance will pay for the DS.  I have already been approved for the RNY but will not settle for anything less than the DS. My insurance's medical policy states that they will only cover the DS for patients with a BMI > 50, but I know of at least 2 people who have had BMIs under 50 who had the DS with my same insurance. Just because it's their medical policy doesn't mean it's not flawed. Neither the NIH nor Medicare state that the DS is only for the SMO. There are NO published studies or peer review articles that state that the DS is not effective on patients with a BMI< 50 or that the DS should only be used for one class of obesity.