Hi. I am new to site.

[hilary1617]

Hello and welcome @kim79 ! Hope you will find the information you need here and I look forward to following your journey.

Further to the above notes, there are two procedures that surgeons are presently referring to as a "Duodenal Switch". Both involve a Vertical Sleeve Gastrectomy with intestinal reconfiguration.

(1) Traditional, full, two anastomoses Duodenal Switch for which long term data is available.
(2) Relatively newer, experimental one anastomosis procedure for which long term data is not yet available. This procedure referred to by multiple names, including Duodenal Switch, which is not appropriate, given it is a different procedure, but also, SADI, SADI-DS, Loop DS and SIPS.

For the traditional full, DS, there are two main approaches:
(1) Hess, an individualized method, where the limb lengths are proportional to the total length of a given person's intestines, (This is top notch) and
(2) Cookie cutter, based on a fixed length of common channel. (This is what I've undergone. I have a 100 cm common channel and am pleased with results).

All the best!
Hilary

 

[kim79]

my insurance will only pay of the (CPT code 43845) which I believe is the HESS method. Again I am learning so much from everyone and I am so grateful to all of you. I think the worst part will be the 3 month dietician process. Then the letter of medical necessity to my insurance to then again to know I might still be denied. As of right now I have no other medical issues other than being so over weight. I am hoping to prevent them from happening. I do not want to develop any weight related health problems down the road.

 

[aaa]

Hello @kim79.

 

[Larra]

@kim79 keep in mind that the requirements for a revision in your policy may be different from those for a first time bariatric surgery. Granted your surgery isn't exactly a revision because your lap band was already removed, but it might be perceived as such. This might work in your favor or it might work against you. So you need to read your EOC to know where you stand.
Also, you have the right code for a DS, BUT there are some surgeons out there using that code and doing the other operation even though it doesn't conform to what the code says. There is no code for the SADI/aka SIPS/aka loop DS because it's experimental. So they either use this code incorrectly to get coverage, or cobble together a couple other codes. At some point insurers are going to catch on to this. You can avoid the whole problem by going to a surgeon that you know does the real standard of care DS that your code covers. It's sad that patients have to be so very careful and ask all the right questions, but that's how it is.

 

[kim79]

@kim79 keep in mind that the requirements for a revision in your policy may be different from those for a first time bariatric surgery. Granted your surgery isn't exactly a revision because your lap band was already removed, but it might be perceived as such. This might work in your favor or it might work against you. So you need to read your EOC to know where you stand.
Also, you have the right code for a DS, BUT there are some surgeons out there using that code and doing the other operation even though it doesn't conform to what the code says. There is no code for the SADI/aka SIPS/aka loop DS because it's experimental. So they either use this code incorrectly to get coverage, or cobble together a couple other codes. At some point insurers are going to catch on to this. You can avoid the whole problem by going to a surgeon that you know does the real standard of care DS that your code covers. It's sad that patients have to be so very careful and ask all the right questions, but that's how it is.

I really cannot believe doctors would be so sketchy. A, its sad, and b, it makes me angry that we are supposed to be able to trust them and know that we really can't. So if I ask him the questions can I believe him? or do just not go to him?

 

[Larra]

If you go to Dr. Smith, you will be in good hands, and you will get a real standard of care DS. Anyone else in your state you better ask some very specific questions and be prepared to walk out the door in you don't get the right answers.

 

[kim79]

do you know where he practices? I live in Jacksonville

 

[Larra]

I don't, but @Mermaid is one of his patients. I've tagged her so hopefully she'll chime in.

 

[kim79]

I don't, but @Mermaid is one of his patients. I've tagged her so hopefully she'll chime in.

Thanks.

 

[southernlady]

do you know where he practices? I live in Jacksonville

He's in Celebration, FL.

The surgeon in Jacksonville is known for deceiving patients by telling them they are getting the DS and giving them the SADI/LoopDS/SIPS. In my uninformed opinion that is assault and battery.

 

[galaxygrrl]

I can not even imagine how that would feel.

It's one of the best things ever! You have started the journey. You will get there.

 

[Clematis]

Dr. Sharma in Jax does real DS and has done it for one of our people here. She has said very good things about him. However he will not take out a healthy gallbladder so 11 months later she had to go back after gallstone attack and have it taken out.

 

[kim79]

Dr. Sharma in Jax does real DS and has done it for one of our people here. She has said very good things about him. However he will not take out a healthy gallbladder so 11 months later she had to go back after gallstone attack and have it taken out.

I had my gallbladder out when I had crapband. I have found two that sound like they do it that are covered by my insurance. I will look into dr sharma tomorrow and Dennis smith to see is they are covered by my insurance.

 

[DianaCox]

Watch out for MDS as another shady way to mislead you into a one-anastomosis experimental procedure.

http://www.soard.org/article/S1550-7289(16)30666-9/abstract
"Modified Duodenal Switch (MDS) or SIPS (Stomach Intestine Pyloric Sparing) Results and Significance"

 

[kim79]

I am pretty sure Dr. Sharma takes my insurance!!!!! He is also, located close to where i work so i could do appt on my lunch breaks. I am taking this as a sign today.