Question:
Does anyone know of good standing surgeons in NJ-PA area that takes Aetna USHeathcare
Help! Looking for surgeons that accept Aetna USHeathcare-HMO to do the Duodenal Switch surgery. Cannot seem to get a consult until 2004! I live in Trenton, NJ I am willing to travel to PA, possibly NY. Most offices I have called either do not accept the insurance or do not return phone calls. Help! — Ms. Belinda M E. (posted on June 4, 2003)
June 3, 2003
According to Aetna's policy bulletin #0157 - Jan 2003 -
(http://www.aetna.com/cpb/data/CPBA0157.html), they only cover RNY and VBG
surgeries. If other's have used Aetna this year for the Duodenal Switch,
hopefully they can tell you how they got Aetna to pay for it.
Good Luck.
— Carolyn M.
June 3, 2003
As the previous poster said, Aetna doesn't cover the DS. As far as
waiting until 2004 for a consult, the good surgeons (like Drs. Raper and
Williams at HUP) will have that kind of waiting list. Dr. Raper did my
open RNY in 7/02 and Dr. Williams did my wife's lap RNY last month. I
recommend both of them highly. You can make the appointment for the
consult and then call every week or so to see if there have been any
cancellations (people end up making appointments at multiple surgeons - a
practice that I detest, by the way, as it contributes to the long waiting
lists - and cancel appointments when they get in sooner someplace else).
A couple of people on the HUP waiting list with consult dates in early 2004
called and lucked out and now have consult dates in June and July...JR
— John Rushton
June 3, 2003
Again, as other posters have pointed out, Aetna does not cover the DS.
However, for RNY, included Drs of good reputation in NJ are Dr Nussbaum in
Livingston, and Dr Romanelli in Neptune and Dr Greenbaum in Willingboro.
In Staten Island is Dr. Heather McMullen (my surgeon), and in NYC is Dan
Herron. Good Luck
— Nannette
June 3, 2003
I would highly recommend the Mehta Bariatric Center located in Somerset,
NJ, about 30 minutes from Trenton. Dr. Mehta performs the RNY
laparoscopically. You can reach Dr. Mehta at (732) 745-0999, or
www.mehtabariatriccenter.com
I live near Philadelphia and I tried to get a reasonable consult date with
surgeons there, but they are booked until winter 2004.
Dr. Mehta was selected for a fellowship in laparoscopic bariatric surgery,
and this surgery accounts for 100% of his practice. Personally, I felt
that it was important to choose a surgeon that performs this procedure as a
sub-specialty, rather than a general surgeon.
Also, whomever you finally choose, make sure that they are not listed on
this website about sanctioned doctors, www.questionabledoctors.org I
actually saw one of the Philadelphia surgeons on that list.
Best of luck. If you call Dr. Mehta's office, you may get a consult within
two to four weeks.
Dave
— David F.
June 4, 2003
To the previous poster - how could you have seen one of the Philly doctors
on there when PA is not on the Questionable Doctors' database. Please
e-mail me offline via my profile and let me know the name as I have friends
that are looking into WLS and want to steer them away from such a
doctor...JR
— John Rushton
June 4, 2003
Hi Dr William Peters in Peckville (near Scranton) PA, does the DS and I
believe He does take Aetna. He is a surgeon listed with this site and He is
wonderful. Cant wait to have him do my surgery.....Hope this helps
— lillbitofsin
June 4, 2003
When using sites such as www.questionabledoctors.org make sure that you do
a nationwide search, since many docctors are licensed in multiple states.
Also, if they had a problem with a sanction or license suspension in one
state, they are likely to relocate to an area outside of that particular
media scope.
The internet provides many great research tools, use them to educate
yourself to at least be prepared to ask questions.
— David F.
June 4, 2003
I had Dr Peter's in Peckville, not sure about the insurance but he is
wonderful! Nothing but praise for him. I am 7 months out and down 97 lbs!
Wendy
— Wendy H.
June 4, 2003
David - I would advise <b>you</b> to do better research before
you accuse someone of being sanctioned. The surgeon in Philadelphia who
you maintain is sanctioned - you did not post his name publicly (luckily
for you) - is not. <b>You</b> did not do the proper research
to find the surgeon's full name - which is <b>different</b>
from that which you supplied me in the private e-mail. The Philly surgeon
that you thought was sanctioned - who was my wife's surgeon - has never
practiced in those other states. If you *had* mentioned his name here, I
would have passed it along to him to see if he wished to pursue possible
legal action against you...JR
— John Rushton
June 4, 2003
John - I posted information about a research site that I found to be
useful. I did not post names, that is up to each patient to determine for
him/herself. Personally, I would use the information in question and ask
that surgeon if that was him. If that surgeon was offended by the
question, then that would be more of a reason to walk away!
As far as you taking information from this site to be used for possible
legal action, I would question the managers of this site about your
intentions. Furthermore, I would gladly meet you in court at any time.
Later!
— David F.
June 7, 2003
John - I find your message to be truly annoying! The reason people post
questions on here in the first place is because they may be ignorant to
some issues and not know many of the resources to check up on doctors and
insurance and the like. If I was unsure of a doctor's status, I'd probably
ask the question on here too. For you to make a stupid comment like that
about passing this innocent lady's name on to the doctor to go ahead and
pursue this issue is absolutely pathetic. Seems to me like you've lost a
lot of weight and gained alot of ignorance. Please be mindful of this when
you post your replies. Sincerely yours, Sandi Ramos
— Sandi R.
June 7, 2003
Sandi - I've e-mailed you offline about your undeserved comments as I don't
want to start a public debate on this...JR
— John Rushton
June 7, 2003
I don't know any doctors in your area, but I have a comment about Aetna. I
have Aetna PPO and it is true that their CPB#157 says they don't cover the
DS. However, the REASON they don't cover the DS is because THEY SAY it is
"unsafe or inadequately studied." They are WRONG (or liars) and
there are a number of people who are VIGOROUSLY appealing Aetna to External
Review agencies, and the tide MAY BE TURNING. Aetna has been reversed on
External Review more than once, and with any luck, my case (currently with
the CA Dept. of Insurance) will be too in the next couple of weeks. The
reviewing agency for the CA Dept. of Insurance is the same agency that
reviews for the CA Dept. of Managed Health Care (a correllary agency for
appeals from CA HMOs) and last week they REVERSED (possibly for the first
time, if you can believe the DMHC website) a BC/BS HMO denial of the DS
(like me, this patient had been approved for the RNY and the DS denied
because it was "experimental"). The folks at the agency (I got a
connection directly to them) told me they are starting to see a change in
the attitudes towards the DS. And back in January, another patient of my
surgeon's won on appeal through Aetna's own External Review Unit!! I got a
copy of his letter (which Aetna totally ignored in my case, even though I
sent it in with my appeals) and it said the basis for Aetna's denial WAS
WRONG! Why they aren't forced to accept that decision for EVERYONE is
beyond me -- but they still are, despite the fact that they just settled a
lawsuit with the AMA about this and other abuses of their insureds. So my
suggestion is to file your request for the DS, go through the pointless
internal appeals process, and then get an External Review. Good luck! If
the Dept. of Insurance reverses Aetna in my case, you will definately here
it from me on the Message Board!
Diana
— [Deactivated Member]
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