Okay, Wow, Didn't Expect to be Taken in Circles??????? *LONG*

HIPAA?

HIPAA?


What about HIPAA?  The OP put her business out on a public forum.  She got an answer to an insurance question on a public forum.  Her privacy and medical information have not not been compromised.

As someone who has access to people's medical information I err on the side of caution, I wouldn't have responded to a public post with specific information about the patient's insurance or any thing that had been denied by her insurance. 

The OP was questioning if no meant no or if there was some other way to get her insurance company to reconsider.  I don't consider that permission for someone to discuss her information in public.  If the same discussion happened in the waiting room of the doctor's office I would consider it innappropriate and then the OP would have been addressing Pam and not just asking for advice from those of us who have been through this journey.

If Pam had just come on here with  information that named a patient and gave away private information, I would agree.  However, the OP brought her business to a public place.  There are too many people who think their HIPAA rights are being violated without actually knowing what they are.  If the questions are asked with Pam in an office, behind a closed door, that is private.  In an open waiting area, that is not private.  On a public forum is way beyond private.   If she wanted a private response from Pam, she would have called her or gone to the office for a private meeting. 

Okay, I'm going to chime in here too as someone who also deals with personal medical and insurance issues on a daily basis.

The OP could have addressed Pam in a private post and gotten private response specific to her insurance and visit.

Instead she came on here asking our opinion and experience. This did not give Pam the opening to give the specifics of "your insurance will not..." and "Dr. Houston asked us...". Because of Pam's position with the clinic she IS held to a higher level of patient privacy, even on this board.

So, yes, this is a HIPAA violation.

 

 

OK, I'm intrigued.  Please cite the CFR section that covers this.  There was no medical information given, therefore, my thinking that there is no violation. I am unaware of where coverage information is also protected.  I have reviewed the HIPAA information provided by my employer and on the CMS web site.  I'd hate to think that I am misunderstanding the law as the penalties are beyond my desire to pay.  Of course, I plead ignorance to most things so my chances of violating HIPAA myself are pretty slim.

From Pam's message here it sounds like your insurance will pay for the DS.  If you truly want the sleeve then the DS is just the sleeve with a back up plan.   I mean the sleeve gives you the restriction so you can loose the weight.  All DSer's loose the majority of the weight with the restriction - the rerouting of the intestines is the back up plan.  The malsorbsion is what will help you keep the weight off (along with the right food choices).   The only thing I can add about choosing a surgery is do all the research possible.  Now when I went to see Dr. Houston I knew that my insurance covered DS, RNY, and Lapband.   SO I asked him about the DS and RNY - never once did he tell me I should go one route or the other.  I went home and researched until I decided on my surgery.    Now take a couple deep breaths and start reading posts in the WLS specific forums (and the revision forum) also ask Questions there too (and  on the main board) you will get a wealth of knowledge.  

Thank you, John. We're actually looking in to that to see if they do cover the DS and if they do, then Dr. H said we have a fighting chance for them to cover the Sleeve. But I don't want to get my hopes up. I mean, is it even possible that BCBSTN covers DS just not on my specific policy?

Thank you, Pam! I appreciate you taking the time to explain that to me.

What Ronda & Pam said. Dr. Houston is a truly excellent surgeon. He is also very concerned about his patients post-op, their progress - or lack thereof - and their compliance. Once you have whatever surgery you choose, if you choose to have WLS, Dr. Houston and his staff provide fabulous support. It's up to you to follow your post op guidelines.

All that said, lost and confused is not a place from which to make a decision that will affect the rest of your life. Step back, take a breath or ten and start educating yourself. Dr. H can't - won't - make the decision about what kind of WLS you have. He will inform you of the risks and benefits and tell you what you need to do post op to be successful.

You might try this approach - gather as much info as possible, look at your eating habits, look at the different requirements for all the surgeries available and then write up a pro/con list for each one. That should give you a place to start making a decision on whether you want WLS at all, then if you do, it will help you later to decide which WLS.

As for info gathering, read posts on the forums on OH - all the different surgery forums including the Revision board (People who have a 2nd surgery to revise from one type to another like Band to RNY or DS, VSG to DS, etc.). Also read some other websites - I had the DS so can only offer dsfacts.com & duodenalswitch.com. Some of y'all who had other procedures chime in here with legit and informative sites about your procedures. There are also Yahoo groups on WLS.

Dr. H responds best to people who have already educated themselves about their surgical options. He's not a hand-holdy kinda guy (I secretly think he is under the surface but hates anyone to know it LOL). Get your ducks in a row, then go see him again. Anything I can do to help, let me know. Don't forget to breathe!!