BariatricTV ForumGeneral WLS InformationDSWhy is the DS not very common?
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Maria C
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« Reply #50 on: February 10, 2011, 02:39:07 PM »

Insurance Companies are money hungry hogs!... A person's life should not have a price tag on it. It makes me sick Sad ... <---- my oppinion Smiley ...
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ttowe
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« Reply #51 on: February 10, 2011, 03:24:35 PM »

So my question is...as a growing community...what can we do to "affect" things so people can get the type of surgery they feel will be most effective for them?

I always felt that by being a successful WLSer, that that might help future statistics that may help curl things around that the insurance companies will realize that by granting people this surgery, they will actually be saving themselves tons of money.

But I think there needs to be more done.

Any ideas?

T
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southernlady
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« Reply #52 on: February 10, 2011, 03:29:32 PM »

Insurance Companies are money hungry hogs!... A person's life should not have a price tag on it. It makes me sick Sad ... <---- my oppinion Smiley ...

It is actually going to get worse as most companies are going to be dropping the wls option on their policy. If they didn't do it this year, I see many will do it next year. And the one surgery per lifetime cap will also come into play so revisions will also disappear.

Liz
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McNee
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« Reply #53 on: February 10, 2011, 09:05:43 PM »

too much to read tonight, I'll have to come back again tomorrow, but I would like to say something quickly...

my comments have never been meant to be about being disrespectful towards DS as a surgery option or against anyone who has chosen to have DS. My comments about the behavior of some patients were my opinion about something I don't generally see coming from others and was meant to be more a reflection on those individuals hurting the rest... and never about any group in general.

Yes, I did go to the OH boards and maybe got a bit... protective... of the BTV crew in a discussion about DS there, but again it was geared towards the individuals, not the group as a whole, and well, I consider Toni, Lynnda and Mike to be friends, so yea, I was sticking up for them.

But, I think they know me well enough (or least I hope so) that if I was to get out of line there, or here, that they would have no problem in "slapping my wrist" so to speak. And actually, I sort of expect to be held to a higher standard than most.

Anyways, it's past my bed time .. but the other stuff I skimmed over looks very interesting and I'll have to come back to it this weekend.
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Rob... (formerfatdudes.com - positively-healthy.com)
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Maria C
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« Reply #54 on: February 11, 2011, 03:45:51 AM »


It is actually going to get worse as most companies are going to be dropping the wls option on their policy. If they didn't do it this year, I see many will do it next year. And the one surgery per lifetime cap will also come into play so revisions will also disappear.

Liz

Where did you hear this? That is very shocking news. The weird thing is that as of January 1, 2010 HIP of NY added WLS as one of their covered surgeries as long as it is done in a Bariatric Center of Excellence. Also Medicaid and Medicare Covers them all Including the DS. I was hoping that since the government insurance recognized WLS as a surgery that should be covered by insurances that other insurance companies would pick up on it and convert. They really would save a lot more money in the long run. I myself am on two medications Monthly that runs them at least 200 Dollars per refill, and as the comorbidities increase so does the Monthly cost, especially for PCP and specialist visits.
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« Reply #55 on: February 11, 2011, 04:10:24 AM »

I heard from a number of medical professionals last year that Medica was looking to drop WLS (not DS specifically)  from their policies.

It's because of money... while they know WLS does tend to pay for itself within a couple years, they see too many patients having the surgery then switching to different insurance so they've been paying for it a lot without realizing the long term savings.

I heard similar about one other company, but who it was escapes me at the moment.
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Rob... (formerfatdudes.com - positively-healthy.com)
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6-Mo Post-Op: 215 9-Mo Post-Op: 200 Lowest: 190 Now: 210
Maria C
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« Reply #56 on: February 11, 2011, 05:44:51 AM »

I heard from a number of medical professionals last year that Medica was looking to drop WLS (not DS specifically)  from their policies.

It's because of money... while they know WLS does tend to pay for itself within a couple years, they see too many patients having the surgery then switching to different insurance so they've been paying for it a lot without realizing the long term savings.

I heard similar about one other company, but who it was escapes me at the moment.

Hmm.. well if you have Medicaid Its because you cannot afford any other insurance. So I do not see people easily switching to another insurance company after Medicaid pays for their WLS. But there are always the select few that cheat the system I guess.
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southernlady
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« Reply #57 on: February 11, 2011, 07:43:50 AM »

Quote
Also Medicaid and Medicare Covers them all Including the DS. I was hoping that since the government insurance recognized WLS as a surgery that should be covered by insurances that other insurance companies would pick up on it and convert. They really would save a lot more money in the long run. I myself am on two medications Monthly that runs them at least 200 Dollars per refill, and as the comorbidities increase so does the Monthly cost, especially for PCP and specialist visits.

Actually in 2010, Medicare did not cover the VSG, I know because I am on Medicare and it was not an option on the table. They may have covered it as of Oct 2010 but that would only go into effect in Jan 2011. They always change the rules in Oct for the rules to go into effect in Jan.

However, individual companies do not have to add wls as an option to their policies even tho insurance carriers have them covered. So even if BCBS covers it, Your policy with BCBS may not because your employer may not offer it. See the difference?
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McNee
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« Reply #58 on: February 11, 2011, 09:35:02 AM »

I wasn't referring to Medica, not Medicaid/Medicare - medica.com

They're a regular insurance company, but maybe regional..?
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Rob... (formerfatdudes.com - positively-healthy.com)
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6-Mo Post-Op: 215 9-Mo Post-Op: 200 Lowest: 190 Now: 210
southernlady
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« Reply #59 on: February 11, 2011, 09:57:55 AM »

I wasn't referring to Medica, not Medicaid/Medicare - medica.com

They're a regular insurance company, but maybe regional..?

Looked them up, this is the area, they cover: MN, WI, ND, SD so very regional. Guess that's why I hadn't heard of them. Sorry my mistake. Smiley
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MacMadame
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« Reply #60 on: February 11, 2011, 03:10:06 PM »

It's because of money... while they know WLS does tend to pay for itself within a couple years, they see too many patients having the surgery then switching to different insurance so they've been paying for it a lot without realizing the long term savings.

Hmm.. well if you have Medicaid Its because you cannot afford any other insurance. So I do not see people easily switching to another insurance company after Medicaid pays for their WLS.
That's probably why they cover it. They can see the impact on their bottom line.

But I think the other companies are being short-sighted. Yes, if they paid for your surgery and you switch out in 1 year, they don't get the benefit, but if another company pays for my surgery and a year later I switch to yours, your company gets the benefit of my surgery and some other insurance company gets the benefit of your surgery so it all works out.

What I see happening is insurance companies still having it but charging a premium for the service so that most companies chose to drop coverage. Then the insurance companies can say "hey, we offered it. It's Big Enormous Company's fault for not being willing to pay for it."
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Maria C
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« Reply #61 on: February 12, 2011, 10:29:02 AM »

I wasn't referring to Medica, not Medicaid/Medicare - medica.com

They're a regular insurance company, but maybe regional..?

oh sorry Smiley.. I thought it was a typo.. lol.. Smiley I understand now
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mandi
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« Reply #62 on: February 13, 2011, 06:14:22 AM »

The original post was made about a year ago. What a difference a year makes!

I went to OH, and DSFacts.com, and Pubmed, etc. I researched every option, though I admit that while I was at first looking at the LapBand, the more I investigated it, the less I wanted it. In fact, I think it should be used for only special situations and not as the primary weight loss surgery sold on TV. That's my opinion, I know there are many happy LapBanders, and more power to you. For me, it was even money between the other 3 surgeries for a bit.

I researched for probably too long. I think the RNY and VSG may be perfect for some folks, but I don't believe they were enough for me since my BMI is 60, etc. I consulted with 4 DS surgeons, and finally settled on one. I get switched March 8th. I can't wait. I have protein samples, blender bottles, an abdominal binder, vitamins... I am so ready and probably still completely unprepared.

If I could answer my original post from 1 year ago, I'd tell myself that the DS isn't common yet, but it probably will be more common in the future. Age-wise, it's a younger surgery, has less publicity than the gastric bypass, and has only recently become accepted by most insurance companies. In 10 years it might be neck and neck with the RNY. Who knows?

I have been a lurker / rare poster on OH for a year. Lurked on BTV for the same time, watched every show. It's fantastic even for people with other surgeries or pre-ops because dude, regardless of how your life is changed, it's different because we are (or will be) recovering obese folks.

There are rabid posters on all sides of the surgery war threads. As a pre-op, I have to say, sometimes those threads are helpful when they are more informational than personal.

We all have to constantly defend our WLS choice to the outside world, to the "Didn't you even TRY diet and exercise??" derp drones. We have to defend WLS to ourselves, to our family, to our insurance companies. Everyone has an opinion on your weight and how you should lose it. Even within the WLS community.

In the end, man... If you are happy with your post-surgery situation and healthy, who the hell cares whether you had a RNY or VSG or DS? Yes, I believe the DS is my best option. I'm pre-op though, so damn, no one should listen to my opinion on the matter! Go talk to some vets who had those surgeries. Ask them what their day is like. If it matches your lifestyle goals... git it gurl.

Anyways, since I made this post a year ago and there's been an influx of posts since then, I thought I'd follow-up with my thoughts. Maybe I will post in this thread in a year with some post-surgery joy, I hope. =)
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-Mandi
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« Reply #63 on: February 13, 2011, 09:43:25 AM »

Wonderful post Mandi!

Ian
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Maria C
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« Reply #64 on: February 13, 2011, 10:28:23 AM »

The original post was made about a year ago. What a difference a year makes!

I went to OH, and DSFacts.com, and Pubmed, etc. I researched every option, though I admit that while I was at first looking at the LapBand, the more I investigated it, the less I wanted it. In fact, I think it should be used for only special situations and not as the primary weight loss surgery sold on TV. That's my opinion, I know there are many happy LapBanders, and more power to you. For me, it was even money between the other 3 surgeries for a bit.

I researched for probably too long. I think the RNY and VSG may be perfect for some folks, but I don't believe they were enough for me since my BMI is 60, etc. I consulted with 4 DS surgeons, and finally settled on one. I get switched March 8th. I can't wait. I have protein samples, blender bottles, an abdominal binder, vitamins... I am so ready and probably still completely unprepared.

If I could answer my original post from 1 year ago, I'd tell myself that the DS isn't common yet, but it probably will be more common in the future. Age-wise, it's a younger surgery, has less publicity than the gastric bypass, and has only recently become accepted by most insurance companies. In 10 years it might be neck and neck with the RNY. Who knows?

I have been a lurker / rare poster on OH for a year. Lurked on BTV for the same time, watched every show. It's fantastic even for people with other surgeries or pre-ops because dude, regardless of how your life is changed, it's different because we are (or will be) recovering obese folks.

There are rabid posters on all sides of the surgery war threads. As a pre-op, I have to say, sometimes those threads are helpful when they are more informational than personal.

We all have to constantly defend our WLS choice to the outside world, to the "Didn't you even TRY diet and exercise??" derp drones. We have to defend WLS to ourselves, to our family, to our insurance companies. Everyone has an opinion on your weight and how you should lose it. Even within the WLS community.

In the end, man... If you are happy with your post-surgery situation and healthy, who the hell cares whether you had a RNY or VSG or DS? Yes, I believe the DS is my best option. I'm pre-op though, so damn, no one should listen to my opinion on the matter! Go talk to some vets who had those surgeries. Ask them what their day is like. If it matches your lifestyle goals... git it gurl.

Anyways, since I made this post a year ago and there's been an influx of posts since then, I thought I'd follow-up with my thoughts. Maybe I will post in this thread in a year with some post-surgery joy, I hope. =)

*looking for the LIKE button*
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« Reply #65 on: February 14, 2011, 09:10:35 PM »

Thanks for coming back with a follow up Mandi!
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T2Nashville
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« Reply #66 on: February 15, 2011, 09:22:57 AM »

Mandi - please come back and keep us posted on your progress. It will be really great to follow a DS all the way through the process. Thanks so much!
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Fran
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« Reply #67 on: February 18, 2011, 08:32:44 AM »

Quote
Also Medicaid and Medicare Covers them all Including the DS. I was hoping that since the government insurance recognized WLS as a surgery that should be covered by insurances that other insurance companies would pick up on it and convert. They really would save a lot more money in the long run. I myself am on two medications Monthly that runs them at least 200 Dollars per refill, and as the comorbidities increase so does the Monthly cost, especially for PCP and specialist visits.

Actually in 2010, Medicare did not cover the VSG, I know because I am on Medicare and it was not an option on the table. They may have covered it as of Oct 2010 but that would only go into effect in Jan 2011. They always change the rules in Oct for the rules to go into effect in Jan.

However, individual companies do not have to add wls as an option to their policies even tho insurance carriers have them covered. So even if BCBS covers it, Your policy with BCBS may not because your employer may not offer it. See the difference?

I have Medicare and I have been searching which WLS is meant for me. So far it is the DS. I LOVE bacon! LOL Medicare does not cover the sleeve. I called to make sure what exactly was being covered to date. I find it bizarre as the VSG is the restriction part for the DS.
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« Reply #68 on: February 18, 2011, 12:47:41 PM »

I believe VSG started out as part-1 of a 2 part process for the super-morbidly obese... folks where they were just too big to safely do DS or RNY on. the would do a sleeve to help them start losing weight, then go back and "finish the job" later.

But then they started seeing better long-term success with the VSG and it's become more accepted as a stand-alone procedure.
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Rob... (formerfatdudes.com - positively-healthy.com)
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6-Mo Post-Op: 215 9-Mo Post-Op: 200 Lowest: 190 Now: 210
southernlady
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« Reply #69 on: February 18, 2011, 04:39:26 PM »

I believe VSG started out as part-1 of a 2 part process for the super-morbidly obese... folks where they were just too big to safely do DS or RNY on. the would do a sleeve to help them start losing weight, then go back and "finish the job" later.

But then they started seeing better long-term success with the VSG and it's become more accepted as a stand-alone procedure.

Actually the VSG started as a surgery for stomach cancer and that history goes back to 1881. Stomach gastrectomy was first done to cure ulcers, now it's done for cancer before it crossed over to weight loss surgery.

Liz
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McNee
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« Reply #70 on: February 19, 2011, 11:11:40 PM »

True enough, I guess I was speaking specifically as a weight loss surgery.

I think the father of one of the surgeon's where I had my surgery was one of the pioneering doctors when it came to starting to use these procedures for weight loss... and my surgeon worked with him doing all sorts of stomach and intestinal surgeries before moving more in to bariatrics. In fact, day of my surgery he got called in for an emergency assist on a stomach surgery, delaying my surgery by over four hours.

I believe VSG started out as part-1 of a 2 part process for the super-morbidly obese... folks where they were just too big to safely do DS or RNY on. the would do a sleeve to help them start losing weight, then go back and "finish the job" later.

But then they started seeing better long-term success with the VSG and it's become more accepted as a stand-alone procedure.

Actually the VSG started as a surgery for stomach cancer and that history goes back to 1881. Stomach gastrectomy was first done to cure ulcers, now it's done for cancer before it crossed over to weight loss surgery.

Liz
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Rob... (formerfatdudes.com - positively-healthy.com)
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