Karla H.
May 2010
May 26, 2010
Had LapBand in Sept 2008 and lost about 20 pounds.
I'm now back up to 245....thinking about sending an application to the biggest loser.
02/26/08
Mar 09, 2008
I was denied by insurance saying that DS was an investigative procedure.
OK I found out more about my insurance...
Coverage is provided for services and supplies for the surgical treatment of obesity. Benefits are available to you and your enrolled spouse/same-
1. Vertical Banded Gastroplasty – CPT Code 43842
2. Adjustable Gastric Banding – CPT Code 43770 (Laparoscopy, surgical, gastricrestrictive procedure; placement of adjustable gastric band)
3. Open Gastric Bypass – CPT Code 43846 (gastric restrictive procedure, with gastric bypass for morbid obesity, with short limb [150 cm or less] Roux-en-Ygastroenterostomy)
4. Laparoscopic Gastric Bypass – CPT Code 43644 (laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy(roux limb 150 cm or less)
5. Mini-Gastric Bypass – No Specific CPT Code
6. Sleeve Gastrectomy – No Specific CPT Code
It does not cover any malabsorbtive procedures.
Another person on the OH DS Forum has the same insurance and when denied was told it was because it was investigative surgery....but it turned out that she was denied on all her appeals because our insurance does not cover the malabsorbtive procedures..
BUMMER......
OK I found out more about my insurance...
Coverage is provided for services and supplies for the surgical treatment of obesity. Benefits are available to you and your enrolled spouse/same-
- Failed dietary and lifestyle change programs.
- Body Mass Index (BMI) greater than 40 kilograms (kg) per square meter (m2) or BMI greater than 35 kg per m2 in conjunction with severe co-morbidities. Examples of co-morbidities include cardiopulmonary complications, severe diabetes, hypertension, or obstructive sleep apnea.
- To qualify for benefits, the procedure must be a gastric restrictive procedure listed as medically necessary in the Premera Medical Policy on Surgery for Morbid Obesity.
1. Vertical Banded Gastroplasty – CPT Code 43842
2. Adjustable Gastric Banding – CPT Code 43770 (Laparoscopy, surgical, gastricrestrictive procedure; placement of adjustable gastric band)
3. Open Gastric Bypass – CPT Code 43846 (gastric restrictive procedure, with gastric bypass for morbid obesity, with short limb [150 cm or less] Roux-en-Ygastroenterostomy)
4. Laparoscopic Gastric Bypass – CPT Code 43644 (laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy(roux limb 150 cm or less)
5. Mini-Gastric Bypass – No Specific CPT Code
6. Sleeve Gastrectomy – No Specific CPT Code
It does not cover any malabsorbtive procedures.
Another person on the OH DS Forum has the same insurance and when denied was told it was because it was investigative surgery....but it turned out that she was denied on all her appeals because our insurance does not cover the malabsorbtive procedures..
BUMMER......
02/12/08
Feb 12, 2008
Danette and Dr. Buchwald were on vacation last week so she has not called me back with information from my insurance company yet. I called her yesterday and she is supposed to be calling me back.
02/02/08
Feb 02, 2008
Finally spoke to Dr. B. He said it looks like I should have surgery. I spoke with Danette and she is checking to see what my insurance needs. I've already done testing and gotten letters from my PCP. Plus supplied a notebook of information. Hopefully it will go easily from here.
01/20/08
Jan 20, 2008
Haven't written in a while...finally got my upper GI and endoscopy. I'm trying to get phone consult with Dr. Buchwald once he reviews my results. Danette is getting my records and talking to Dr. B...then will call me back.
10/20/07
Oct 20, 2007
I went to Dr. Buchwald's consult/seminar. I got to meet two fantatic women from the OH DS Forum.
Dr. Buchwald wants me to get an upper GI and Endoscopy. He said I have 4 options.
- No surgery
- RNY with a Band
- Change RNY to Distal
- Change RNY to DS
Of course I want the DS and during his seminar, he said he would do the surgery we requested. So I am going to get tests done and proceed from there.
Dr. Buchwald wants me to get an upper GI and Endoscopy. He said I have 4 options.
- No surgery
- RNY with a Band
- Change RNY to Distal
- Change RNY to DS
Of course I want the DS and during his seminar, he said he would do the surgery we requested. So I am going to get tests done and proceed from there.
10/7/07
Oct 07, 2007
I am attending Dr. Buchwald's seminar with Bboop and Bradshaw0506 on Oct 17th. We will all be staying at the same hotel and meeting with a DS support group at Perkins the night before. I am really excited to meet everyone.
9/29/07
Oct 02, 2007
Ok....I thought I had done my homework....guess it wasn't good enough.
I had talked to a few of Dr. Maguire's patients that told me they had RNY revisions to DS or BPD. Turns out he only does an RNY to a Distal RNY.
So I found another surgeon. Dr. Buchwald in Minneapolis, MN. I will be going to his consult/seminar on October 17.
I had talked to a few of Dr. Maguire's patients that told me they had RNY revisions to DS or BPD. Turns out he only does an RNY to a Distal RNY.
So I found another surgeon. Dr. Buchwald in Minneapolis, MN. I will be going to his consult/seminar on October 17.
9/27/07
Sep 27, 2007
Ok...I think I have chosen my surgeon. I am going to a seminar by Dr. Maguire in Dayton, OH on October 12. They will send me a packet in the mail which I must complete and bring with me. I will be flying from Dallas to Columbus. I will be staying in Columbus on the 11th and then drive into Dayton on the 12th and fly back home on the 12th.
9/26/07
Sep 20, 2007
I found out that Dr. K charge an additional $4000 for revisions which is not covered by insurance. Plus he requires you to stay 10 days in a hotel after you get out of the hospital before you go home. very expensive.
So I decided to keep looking for a surgeon who performs the RNY to DS revision. I am looking for one with lots of revision under his belt. So here are the surgeons I have checked out so far (information on all are located on http://www.duodenalswitch.com/ website:
- Dr. Warden in Louisiana has revised a lot of people who have failed RNY by making what is usually a large pouch into a small pouch and sometimes extending the limb length to increase malabsorption.
- Dr. Anthone in Nebraska, he stopped doing RNY to DS surgeries last year.
- Dr. Prachand in Chicago only does RNY to DS revisions if the BMI is over 50
- Dr. Gagner in Florida is switching institutions from New York to Florida and will start at the new place in January 2008. He recommends I wait until January to set up appt. with him. He responded personnaly to two of my e-mails and I've heard he is GREAT!
- Dr. Alverdy in Illinois evaluates case by case but they are very selective
- Dr. Inman in Indiana has only done 20 RNY to DS revisions
- Dr. Lutrzykowski in Michigan wants RNY op report before he decides if he will do revision
- Dr. Lane in Ohio usually does RNY to DS in higher BMI but determines on case to case basis
- Dr. Anderson in Ohio does not do revisions
- Dr. Peters in Pennsylvania does not do revisions
- Dr. Shah in does on a case to case basis
- Dr. Deveney in Oregon performs RNY to DS revision
- Dr. Husted in California performs RNY to DS revision
- Dr. Antelmo Sasso Fin in Brazil does RNY to DS revision
- Dr. Maguire in Ohio does not do an RNY to DS revision but does a distal RNY
- Dr. Greenbaum in New Jersey has done 50 DS surgeries and 8 DS revision.
- Dr. Roslin in New York does DS but when doing a revision from RNY, makes it a distal RNY does not do RNY to DS.
- Dr. Feng in California does not do RNY to DS surgery
- Dr. Jossart in California has done 150 DS surgeries and has done many revision.
- Dr. Schlosser in Minnisota is no longer working in
- Dr. Maynard in Georgia does DS but in his response did not mention revisions. Did urge to attend seminar for more questions.
- Dr. Cirangle in California has performed hundreds of DS procedures including revisions from RNY.
I am reasearching all my options. If you know of any or have any updates on other surgeons please e-mail me.
So I decided to keep looking for a surgeon who performs the RNY to DS revision. I am looking for one with lots of revision under his belt. So here are the surgeons I have checked out so far (information on all are located on http://www.duodenalswitch.com/ website:
- Dr. Warden in Louisiana has revised a lot of people who have failed RNY by making what is usually a large pouch into a small pouch and sometimes extending the limb length to increase malabsorption.
- Dr. Anthone in Nebraska, he stopped doing RNY to DS surgeries last year.
- Dr. Prachand in Chicago only does RNY to DS revisions if the BMI is over 50
- Dr. Gagner in Florida is switching institutions from New York to Florida and will start at the new place in January 2008. He recommends I wait until January to set up appt. with him. He responded personnaly to two of my e-mails and I've heard he is GREAT!
- Dr. Alverdy in Illinois evaluates case by case but they are very selective
- Dr. Inman in Indiana has only done 20 RNY to DS revisions
- Dr. Lutrzykowski in Michigan wants RNY op report before he decides if he will do revision
- Dr. Lane in Ohio usually does RNY to DS in higher BMI but determines on case to case basis
- Dr. Anderson in Ohio does not do revisions
- Dr. Peters in Pennsylvania does not do revisions
- Dr. Shah in does on a case to case basis
- Dr. Deveney in Oregon performs RNY to DS revision
- Dr. Husted in California performs RNY to DS revision
- Dr. Antelmo Sasso Fin in Brazil does RNY to DS revision
- Dr. Maguire in Ohio does not do an RNY to DS revision but does a distal RNY
- Dr. Greenbaum in New Jersey has done 50 DS surgeries and 8 DS revision.
- Dr. Roslin in New York does DS but when doing a revision from RNY, makes it a distal RNY does not do RNY to DS.
- Dr. Feng in California does not do RNY to DS surgery
- Dr. Jossart in California has done 150 DS surgeries and has done many revision.
- Dr. Schlosser in Minnisota is no longer working in
- Dr. Maynard in Georgia does DS but in his response did not mention revisions. Did urge to attend seminar for more questions.
- Dr. Cirangle in California has performed hundreds of DS procedures including revisions from RNY.
I am reasearching all my options. If you know of any or have any updates on other surgeons please e-mail me.
