Help? Anyone?

I have Wisconsin Medicaid, BadgerCare and Compcare. I know they don't cover the Duodenal Switch, just the Lap Band and the RNY. I don't want either of them, and want to try fighting them for the DS. I can't have the RNY cuz I need NSAIDS for my migraines, plus all the other good sides of the DS :)    and I need this surgery. I am 23 and in such bad health.
Can anyone help me out with any ideas??







Covered Services

Effective for DOS on and after February 1, 2005, Wisconsin Medicaid covers two new laparoscopic bariatric surgery procedures:

	43644 (Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy [Roux limb 150 cm or less]).
	43645 (Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption).

The Attachment of this Update contains a chart that lists the bariatric surgery procedures covered by Wisconsin Medicaid. All bariatric surgery procedures require PA.

Services That Are Not Covered

The following procedures for bariatric surgery are not covered:

	43845 (Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy [50 to 100 cm common channel] to limit absorption [biliopancreatic diversion with duodenal switch]).
	S2082 (Laparoscopy, surgical; gastric restrictive procedure, adjustable gastric band [includes placement of subcutaneous port]).
	S2083 (Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline).
	S2085 (Laparoscopy, gastric restrictive procedure, with gastric bypass for morbid obesity, with short limb [less than 100 cm] Roux-en-Y gastroenterostomy).

In addition, the following procedures are considered investigational, inadequately studied, or unsafe and therefore are not covered:

	Gastric balloon.
	Biliopancreatic bypass.
	Loop gastric bypass.

I see the DS there. It does not say WHY it is not covered. It is not listed under the UNSAFE of INVESTIGATIONAL list.... Do I have a good chance to fight it and get it approved? Or they just going to say no no no! and drop me like a bomb?  I hear it's easier to fight if its investigational or what not, but if it is straight up not covered, whats going to happen? Anyone been thru this?
I am determined to get this surgery but I am sooooo scared that I am going to go thru all my appointments and lose it all.

Have you thought about having VSG? It is the first part of the DS surgery and there are lots of success stories from folks with just the sleeve. VSG is not listed under your "not covered" surgeries.

I think I am going to look into it