What to Do????
I am soooooo sick from insurance bs!
They not covered DS , only gastric bypass.Period! Dr Pomp called to HIP of New York and they will pay only for Gastric bypass, not DS.
Why? It is not because DS is experimental, they just do not pay for it.What should I do?
I am thinking about distal RNY for my husband.
I think this a better then nothing.
Alla
PART 1 VSG 03/28/2006; PART 2 DS 01/31/20007
Alla, before you give up on Ds for your husband, please check with your husband's insurance company regarding appealing their decision. Also check to see if your state has an external appeals process. Most states do, and if you go through your company's appeal process and they still deny the Ds you can go to the external appeal process. I don't know about NY - hopefully someone else will - but in CA, where I live, we have the Dept. of Managed Health Care, and they usually overturn the various health insurers denial of the DS.
Look into it, and good luck!
Larra
Here's a thread that Diana, our insurance fighting dynamo posted a while back about fighting that very subject:
http://www.obesityhelp.com/forums/DS/a,messageboard/action,r eplies/board_id,5357/cat_id,4957/topic_id,3515897/
Valerie
DS 2005
There is room on this earth for all of God's creatures..
next to the mashed potatoes
Sorry to hear about your delemia. I have HIP Prime of NY and had the VGS/DS done in 2 stages by Dr.'s Dakin & Dr. Pomp. I don't think Dr Pomp is a HIP approved Dr. but Dr Gregory Dakin is. Dr. Pomp assisted Dr Dakin with the surgery because of the complexity of the surgery and HIP approved to pay Dr Pomp to assist. My pre surgery BMI was 50.2. I don't know what your husband's BMI is or his co-morbities are, but they may have something to do with their decision. I'd call back the dr's office and see if Dr. Dakin can help. He's a very good and young surgeon. Also, call HIP and find out yourself why they are denighing it.
Do not walk away from this and let the *******s win! You appeal this decision as high as you can! If this is no longer experimental by medicaid then it is not experimental...period. Appeal...then go to the State Insurance Commission.
The way my insurance co got around this is we could not go out of system for a surgeon and there were no DS surgeons in the system.
Appeal...because the quality of the rest of his life depends on this!
Dianne from FL
SW / GW / CW 5'10"
306 / 165 / 140
With the DS: there is no stoma, so no stoma strictures; there are no limitations (other than volume) against drinking before, during or after meals; 80% of ingested fat is malabsorbed; 98.9% of type II diabetics are CURED of this devastating disease, with data showing stable cure over 10 years out; there is the best average weight loss and most durable (average 76% excess weight loss going out 10 years) of all of the bariatric surgeries. That's why I had a DS!
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