Question:
I was only approved for the RNY and I wanted the DS what would you do?
I wanted to know the opinioins of you all out there. Would you go for second choice or wait until you can find another way of getting the surgery you want? I am extremely overweight w/o any serious health problems..yet. I am also getting very depressed over my weight and I let it keep from doing a lot of social activity. I am supposed to graduate from college and I don't want to accept my degree in front of thousands of strangers and family looking like this. Please help. — davesband1 (posted on December 28, 2003)
December 28, 2003
Unfortunately, most insurances will not cover the DS as it is still
considered an experimental type surgery. I know some insurances will cover
the Lap Band, all (at least all that cover the surgery at all) will cover
the RNY, but very few, if any, will cover the DS or other types of WLS.
If you really have your heart set on the DS, you might want to find a
surgeon who will take you on a payment schedule for self-pay.
Good Luck
— Carolyn M.
December 28, 2003
If I had life-threatening comorbs I think I'd settle for the second choice
because any WLS is better than dying fat. BUT since you seem to still be in
good health, I would say that it's worth it to spend some more time trying
to get the surgery you want. You've got to live your whole life with
whatever surgery you get, after all!
Have you posted over on the DS groups to get some advice on handling the
insurance issue? If not, you might want to go over to
http://duodenalswitch.com/openbb/ and ask about how others have dealt with
your insurance. I know I've heard of people successfully fighting against
the "experimental" thing, so maybe there's still hope? Good luck
to you. :)
— K M.
December 28, 2003
I personally had the DS, I knew when I chose it I would not settle for
less. Unlike a what a former poster said, it is not considered experimental
anymore, it has been accepted bythe NIH. To me it is the Platinum standard
for WLS. I see you have BCBS, I know of people out here in AZ approved with
BCBS. I know insurance is different everywhere, but there is hope. Now if
you are ok with RNY then go for it, obviously there are tons of successful
people on here who have had RNY. It is a personal choice as to what surgery
you want. I wish you the best.
— Stephanie B.
December 28, 2003
FIGHT, FIGHT, FIGHT for the DS if that's what you want -- I was approved
immediately with Aetna for the RNY, when I had asked for the DS. I
appealed through all the internal appeals at Aetna (what a worthless
frustrating exercise that was), then appealed to the Calif. Dept. of
Insurance, where I lost a 2-1 decision; then and only then was I allowed to
speak with an attorney inside Aetna, and I explained clearly and
unequivocally that I was going to SUE THEIR ASSES and win an ERISA case
against them, pointing out exactly how and why (I'm an attorney, but not
any practical type of attorney -- I just did my research, which I will be
happy to share with you), and within days, she got me approved. If you go
to
http://health.groups.yahoo.com/group/DS-Insurance_Authorization_Problems/
you will find more help, including a copy of the ASBS Resolution passed
last June stating that the DS is NOT experimental, investigational, or any
of that lying crap the insurance companies try to use to make you give up
and go away.<P>
I am now 4-1/2 months post op and ABSOLUTELY CERTAIN this was the right
surgery for me. I eat almost normally (perhaps too normally -- I'm
"only" down 58 lbs., but I'm 50 years old and have a sedentary
job and don't do any exercise right now) and feel terrific. I've already
thrown out the bulk of my fat clothes and moved into some of my old good
stuff. If you feel like you are pretty sure that the DS is also right for
you, DO NOT SETTLE for a second-best surgery. The DS is the platinum
standard. If your BMI is over 50, you have a more than decent chance of
getting the insurance company's denial overturned. And if not, I would
seriously consider self-paying for the RIGHT surgery for you -- you will
have to live with the results for the rest of your life. Keep in mind that
revision of an RNY to a true DS is often not possible, because the lower
part of the stomach left in the RNY is often unsalvageable as a functioning
stomach, as the pyloric valve function is often lost through disuse. Do it
once, and do it right.<P>
Good luck, Diana
DS Robert Rabkin 8/5/03
285/227/160?
— [Deactivated Member]
December 28, 2003
I'm with the others on this. It IS a big decision and one you'll be living
with for the rest of your life. If you're certain the DS is the lifestyle
and choice you want then make the sacrifices for it. There are folks who
simply don't want an RNY and find a way to make the DS happen for
themselves. People I know who had the DS with insurance paying had to
fight for it. And it is a long road. Many people either can't win the
insurance, can't wait for insurance, or don't have insurance at all and
still make it happen by self paying. I know 2 ladies who could have had
the RNY paid for by insurance yet chose to self pay in order to get the DS.
One is a doctor's wife, she traveled to Spain. The other is a law student
who saved everything she could, sold everything possible, and went to
Brazil. I hope if the DS is truly what you want that you can make it
happen for yourself too.
— Shelly S.
December 28, 2003
Don't settle for second best. Whatever surgery you wind up having MUST be
something you're confident you can live with for the rest of your life. I
could have had an RNY, fully covered, but I chose to self-pay the surgeon's
fee in order to have the DS. Prior to surgery, I was pretty sure I'd have a
hard time living with a pouch. Now, less than 3 weeks post-op, I KNOW I did
the right thing by having the DS! Adjusting to it's restrictions is hard
enough for me. The pouch would have left me miserable---for the RST OF MY
LIFE.
Do whatever you have to do, because you're young and losing weight is going
to make you live that much longer. Be sure you can do so joyfully!
— MsBatt
December 28, 2003
Let me recommend you go and post on the main DS yahoo group
http://health.groups.yahoo.com/group/duodenalswitch/ - and post this very
question - there are LOTS and LOTS of people who have very successfully
been covered by insurance with little or no hassle. If you do find
yourself in a position needing to add a little leverage to your case, then
consider hiring one of the two law firms that specialize in representing
patients seeking the DS as their preferred choice of WLS -
www.obesitylaw.com and www.obesitylawer.com
If you are committed to the DS, and willing to do what it takes to get it -
and insurance turns out to not be an option for you, then perhaps
self-paying is something you'll want to consider. I went to Dr. Aniceto
Baltasar in Alcoy, Spain for my surgery. It is remarkably affordable to go
out of country for the DS. For more information, see
www.bodybybaltasar.com
Blessings,
dina
— Dina McBride
December 28, 2003
I ran into the same situation and had the RNY. I can't advise you what to
do, but the RNY has worked fine for me - I'm down 100lbs. WLS was the best
decision I have ever made.
— jengrz
December 29, 2003
Hi, Adrian! I see you've gotten a lot of responses from folks who've had
the DS and are very happy with it. If this is what you truly want, then
keep trying. But if you're not up for the fight, or can't self-pay, or
find other insurance, please consider the RNY. I personally know 7 people,
myself and my son included, who have had very successful RNY's, 5 were lap,
and 2 open. It's a great surgery, really! I'm almost 4 months post-op, and
I'm eating normally, just not large amounts. To me, that's a good thing,
because eating large amounts is what got me fat in the first place. My
surgery was proximal, with 75 cm of intestine bypassed. I have lost 54
pounds to date, and feel wonderful. I was 100 pounds overweight at the
time of my surgery. The smaller amount of bypassed intestine makes me feel
a little more confident that I'll not have nutritional deficiencies down
the road, which I guess is one of the bigger risks with the DS. My son's
surgery was performed last May, and he has lost 150 pounds thus far,
starting at 442, and now down to 292. He is also doing extremely well, and
eating normally. I feel that many who have DS believe that you do not
return to "normal," but that is not the case at all. Believe me,
even at 4 months out, I feel and look better than I have in years. I'm
loving this, and am so grateful to have had a wonderful surgeon perform
this amazing surgery for me. Even if this is your second choice, it's
still a great one. Good luck, whatever your decision.
— Carlita
December 29, 2003
You can continue to fight insurance and possibly win but that will take
alot of time and effort on your part. You can also self-pay though if just
graduating from college thats alot to debt to start off your post-grad
life. And if your goal is to graduate soon and not be obese during the
graduation, I'd suggest you have the RNY. If you have the time, though,
then pursue what you really want.
— Cindy R.
December 29, 2003
I would have the RNY, I have had awesome results from mine!!!
— bikerchic
December 29, 2003
If you are not going to be able to self-pay within the next year or two
then I personally think you are nuts to pass up having a WLS that will
definitely provide you with great success. I am a huge proponent of each
person finding the "right" surgery for them, but the reality is
most insurances will not cover the DS. Eventually they most likely will
but are you medically able to survive that long?
<p>I know that most DS people feel that it is the "only"
surgery for a SMO, but I disagree. I am down 207 lbs in 10-1/2 months and
35 from goal - started at 442. I am very comfortable with the amount of
food I eat etc. It is very normal for me now. I do tolerate small
quantities of sugar, in fact I had a turtle chocolate this morning and
tolerated it fine. Now if I had been dumb enough to eat two I would have
been miserable. Because I can tolerate small quantities of sugar I am very
comfortable with this life. The big thing that works is that I am truly
full! I'm not on a diet nor eating diet food. Some do but I do not. I
eat regular food in smaller quantities. I still stay quite protein focused
and likely will forever. I feel great and would not change my mind about
anything.
<p>For me I needed a new relationship with food and being able to eat
tons, just like before surgery, was not the mental change I needed. I
needed a total transformation. The RNY isn't for everyone, nor is the DS
etc. I had already determined that I did not want the DS, which was good
as BCBS would not cover it. Just because the procedure is accepted by the
NIH does not mean insurances have to cover it.
<p>The main thing is that if you go ahead with the RNY you cannot go
ahead feeling like you are settling for 2nd best as it will set you up for
failure. In my opinion 95% of our success long term is mental and how we
feel about what we have done and what changes we are going to make etc. If
you are going to get an RNY and try and eat like a DS or feel like you are
on a diet forever, then stay the way you are, because you do not want to
trade one hell for another. Your mind has to be on board with the final
choice you make. Good Luck in your decision.
— zoedogcbr
December 29, 2003
If given a choice between surgery for free or fighting for my first choice
with no guanrantees,I would pick rny.Sometimes you dont always get what you
want,or Gods greatest gifts are unanswered [prayers.Personally,I wouuld go
for the surgery that was covered as whats most important is your weight
loss and self esteem.RATHER HAVE SECOND CHOICE THAN NONE AT ALL.Life gives
you lemons,make lemonade I say.Make rny your lemonade and see your glass as
half full.Good luck.
— glori74
December 29, 2003
If you dont mind me asking why dont you want the RNY?
— bob-haller
December 29, 2003
One other reality that you might want to factor in. If you self-pay and
get the DS you can forget about any complications/issues being covered by
insurance for the rest of your life most likely. That is a huge advantage
to going with the RNY, which you said would be covered. Then any
complications are covered, within the limits of your policy.
<p>I ran into this situation when I questioned my choices for
insurance for 2004. I asked one of the HMO companies available to me if
they would cover any problems that might arise. They said no. However, I
would not accept that answer as I had my RNY covered by one of the other
policies available to us. The final decision was that the HMO would have
to cover anything related in the future to my RNY. However, they said if I
had had the surgery and it wasn't covered by one of the policies in the
first place then the HMO would not have to cover anything. Someone who
went to Mexico to have the Lap Band ran into this and now she has lots of
medical bills to pay herself. So there are many aspects to consider. Do
not assume you won't have any complications no matter which surgery you
have. Assume the worst and plan accordingly.
<p>I personally think both surgeries are wonderful and I'd get
whichever one will be covered. The life of an RNY is not a problem. You
do fine with the small quantity of food as that's all there is room for and
you are full! Just make sure you use a very good RNY surgeon and one that
transects. I also would make sure the surgeon does a 150cm bypass and
small pouch in your case as it will help you in the process and long term
maintenance. The longer bypass will be a little more forgiving if you
deviate once in a while. It's a matter of making some minor adjustments.
— zoedogcbr
January 2, 2004
To the previous poster re: self-pay and complications. I was self pay and
fortunately didn't have any complications but my insurance has paid for all
my aftercare visits with my pcp and my labs each quarter. The insurance
company even stated that they would reimbuse part of the cost of surgery
out of network & country (as soon as I get all the paperwork together
which I have to do before March!). Cera - Open DS 3/18/03 down 104# and
at goal!!
— Cera H.
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