Anyone with BCBS and the DS?

Hello,

Has anyone had BSBS of MA cover the Duodenal Switch surgery?

Background:
I have BCBS of MA which has coverage for the Band and RNY.  Their Policy #379 states they do not cover the DS because it has "not scientifically proven to result in improved net health outcomes for obese patients and therefore are investigational and do not meet the BCBS of MA Medical Technology Assessment Guidelines, #350."

However, further in Policy #379, they state "for many of our medical policies, each individual's unique clinical cir****tances may be considered in light of current scientific literature.  For consideration of an individual patient, physicians may send relevant clinical information to.... "

I am just curious if anyone has had it covered and if you asked for it right away in your documents or if you got approved for WLS in general first and then submitted documentation for the DS?

Your experience and advice is appreciated!

KC

I called BCBS and asked the question. Basically I was told that because they did cover the RNY which is "proven" that they would not see a need for covering DS.

If you wanted to go further than I did (I really was leaning toward RNY anyway) then you may find more information that would support your case.

I would suggest that you post this question to the DS board for those that may have gone through the process.

Martha

Thanks Martha!