Question:
How can I get my insurance to approve the DS surgery?

Any ideas on what I can say to my insurance company to convince them of approving the Duodenal Switch. They will cover the RNY because they have several in-network surgeons for it, but not for the DS. I want the DS. Any ideas?    — [Anonymous] (posted on October 1, 2001)

October 1, 2001
Well if this is the only dr that can perform this surgery your insurance needs to consider that, you will need to file a appeal if it has been denied for that reason. Also you will need your surgeon to write a letter explaining the difference between the two surgeries and then send that in with the appeal, I wish you luck in this and I hope that it is approved
   — Patti S.

October 1, 2001
Since they cover the RNY, they will only cover the DS if you appeal with clinical documentation supporting that there is a medical necessity for the DS procedure and that the RNY would be harmful and/or ineffective. What you "want" doeesn't factor into it. You certainly have an uphill battle.....good luch.
   — [Anonymous]

October 3, 2001
Don't give up! I had a friend who's insurance here in CA, only covered RNY. After much fighting, they approved him for a RNY. After researching surgery types more, he discovered the DS and became very convinced he wanted the DS and not the RNY. Basically, he educated the insurance company on the benefits of the procedure and was the first one in CA to be approved for the DS with Lifeguard in CA. Since his surgery, others have been approved for the DS with the same insurer. Education is the key. Don't give up! Good luck to you!
   — [Deactivated Member]

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