What made you pick RNY over DS?

[Remingtonh]

If I remember correctly (and I think I do now), he said the "code" was not specifically for laparoscopic DS, and though he gets pre-approval, he has to submit the claim using no code (or a code for "other") and an explanation of the procedure, and insurance companies often have issues with that and deny the claim. If I pay the $8K up front, he will submit the claim and try to get an approval. He said that if I chose to go that route, that I should only do so knowing that I may not get refunded.

 

[southernlady]

If I remember correctly (and I think I do now), he said the "code" was not specifically for laparoscopic DS, and though he gets pre-approval, he has to submit the claim using no code (or a code for "other") and an explanation of the procedure, and insurance companies often have issues with that and deny the claim. If I pay the $8K up front, he will submit the claim and try to get an approval. He said that if I chose to go that route, that I should only do so knowing that I may not get refunded.

Then RUN not walk away. There is a code for the DS but no code for SADI/SIPS/LoopDS. That’s why they submit under “other” which is fraud with the insurance companies. As of now, I’ve only heard of one insurance company in Utah (small one) that covers the still experimental procedures. There was a BCBS in S. California and in N.C. That covered it for less than a year and then stopped due to it’s still experimental nature.

 

[DianaCox]

I too have a recollection that Ganta was sketchy but I can’t find any specific discussion about him in my emails - it was probably on another site.

His explanation is VERY sketchy. I’d look elsewhere.

I’m vaguely recalling that I know a DSer who used him years ago - I’m going to reach out to her and see what she knows.

 

[Remingtonh]

I may swing over to the office at lunch, since it's close to my work. If they'll talk to me, I'll ask if they do the two anastomosis DS and ask them about code 43845, and show them this from my insurance company:
https://www.uhcprovider.com/content...icies/comm-medical-drug/bariatric-surgery.pdf

Anything I'm missing?

 

[galaxygrrl]

I may swing over to the office at lunch, since it's close to my work. If they'll talk to me, I'll ask if they do the two anastomosis DS and ask them about code 43845, and show them this from my insurance company:
https://www.uhcprovider.com/content...icies/comm-medical-drug/bariatric-surgery.pdf

Anything I'm missing?

As how many true DS's. If he has not done many, I would go somewhere else.

 

[RedSkittles]

This post was forwarded to me for comment.

Dr. Ganta did my DS surgery in 2007 and he also later removed my gallbladder as well. Based on my experience, I really have nothing but positive things to say. I think he's a capable surgeon. I had no issues with insurance coding or coverage whatsoever, and had no surgical complications.

That said, 6 months after my surgery, I did hear that there were coverage issues and he began requesting additional fees to complete the DS surgery but not any other surgery. I do think as a result of this practice, his DS business trailed off and Dr. Stewart's Denton, TX DS practice flourished. Back when I did my surgery, Dr. Stewart and Dr. Ganta both had done similar # of surgeries...believe it or not! [Dr. Stewart has since passed away and practice was taken over by Dr. Ayoola, still in Denton, TX]

I would not blame you for being concerned regarding the coding as that would raise some red flags for me as well. I think it's within your rights to understand fully what surgery is being performed and why you are being charged fees outside of insurance coverage when preauths are done with specific codes.

All things being equal today, I think I would make the trip to Denton for surgery with who I believe is the most experienced DS surgeon in Texas at this point...Dr. Ayoola. 11 years ago I saw no additional benefit to traveling for a surgeon with a similar experience level but that's not the case today! Someone with better knowledge of the Dr. Ayoola's practice will hopefully chime in to confirm there are no such insurance snags at that office.

Good luck! Wish I could be more help. I had a good experience with Dr. Ganta but things with office policies can change though I have no reason to doubt his surgical skill. I don't live in Austin anymore so I have no reason to go see him. My PCP orders all my labs, but if I saw him it would be a happy reunion. He did great work on me so many years ago and changed my life. Sorry to hear that things are wonky now.

All the best to you and I hope these snags work themselves out. No way would I pony up $8k without knowing I could get it back. I wouldn't pay more than my deductible, personally.

 

[Remingtonh]

RedSkittles, thank you so much for this information. Everything seems to be adding up now regarding the DS insurance issues.

I have gone back and forth on this. I have not had issues losing 100+ on diets in the past (2 or 3 times), and have good will power overall, but keeping it off long term has been an issue (my fault). I think I just need a little extra help that surgery can provide. I've known someone in my past that had good long term success with the RNY, and that's why I have agreed to it over the last 6 months during pre-op stuff.

If I was 45-50+ BMI, had not had luck with diets in the past etc., I think I would push harder for the DS, but I think at this point I'm going to go ahead with the RNY (that's already scheduled for this month) and try my best to make it work. I have had acid reflux issues in the past, and RNY seems better for that than sleeves or DS, from what I understand.

 

[southernlady]

RedSkittles, thank you so much for this information. Everything seems to be adding up now regarding the DS insurance issues.

I have gone back and forth on this. I have not had issues losing 100+ on diets in the past (2 or 3 times), and have good will power overall, but keeping it off long term has been an issue (my fault). I think I just need a little extra help that surgery can provide. I've known someone in my past that had good long term success with the RNY, and that's why I have agreed to it over the last 6 months during pre-op stuff.

If I was 45-50+ BMI, had not had luck with diets in the past etc., I think I would push harder for the DS, but I think at this point I'm going to go ahead with the RNY (that's already scheduled for this month) and try my best to make it work. I have had acid reflux issues in the past, and RNY seems better for that than sleeves or DS, from what I understand.

I also could lose weight but not keep it off. My starting BMI was 35.2 (only 68 excess lbs), over 7 years out and maintaining over 100% weight loss.

 

[galaxygrrl]

I have gone back and forth on this. I have not had issues losing 100+ on diets in the past (2 or 3 times), and have good will power overall, but keeping it off long term has been an issue (my fault). I think I just need a little extra help that surgery can provide.

OMG, NOT your fault. You are up against genes, a toxic food environment and so much more. Only 2% of people who lose 50 pounds or more keep it off two years later. Those odds sux. Surgery works, diets don't. It's not you. Get surgery, it works, and move on with your life.

 

[Larra]

The issue with Dr. Ganta, as I recall, had to do with money, similar to what you are now running into. I believe it was also due to some kind of nonrefundable fee, though I don't remember the amount. To me, this is very suspicious.

Regarding the code, almost every DS surgeon does the DS lap, or lap-hand assisted. Clearly, there is no problem with the use of the code. You are being handed a bill of goods to steer you away from the DS, IMHO, and it saddens me to see you falling for it. Regarding your prior difficulties with maintaining your weight loss, join the club. This is NOT your fault, it is the nature of morbid obesity. And as far as the acid reflux issue goes, I would only recommend RNY over DS on this limited issue for someone with severe acid reflux. Unless the surgeon makes an unnecessarily tight sleeve, you should do fine with a DS even if you have garden variety reflux, as do many if not most MO people. You know what - I bet if you wanted a sleeve gastrectomy, he wouldn't let your reflux stand in his way of doing it for you, even though most surgeons make their stand-alone sleeves tighter than they do with a DS.

 

[Remingtonh]

Well I don't think there is really anything I can do about it at this point. I'm already six months in with this doctor, and surgery scheduled this month. I'll mention it to him again when I see him at the next appointment, but I certainly don't want to start the whole process over again...

 

[Larra]

You wouldn't need to start the whole process again. You can transfer all your records to another surgeon. Lots of people have done this.

The feeling I'm getting at this point, rightly or wrongly, is that you are following the path of least resistance. Remember that this decision is something you will live with for the rest of your life. Any short term extra effort is well worth it in the long run. if RNY is really, really what you want, fine. If not, don't settle.

 

[galaxygrrl]

OK, here is the thing. If the surgery gets screwed up, it's a big deal, it's a pain and will be physically painful and emotionally hard. People revise from the RNY to the DS all the time, no one does the other way around.

Just make sure he knows what he is doing and you get the surgery that makes sense. Don't settle on this one. It's not worth it. Just make sure you get what you want and have a good Doc.

 

[k9ophile]

In my experience of using CPT codes (the codes providers use for billing purposes) if there is a code for a specific procedure, that code is used. If there is no code, the provider bills with a vague code and is required to submit supporting documentation. It may be possible that the physician is not familiar with codes as he/she relies on his billing people to know the "rules". I agree with the others, something hinky is going on. Do not have any surgery until you're sure you're getting what YOU want and not what the surgeon wants to perform.

 

[Remingtonh]

Thanks everyone for your collective guidance. I really don't think RNY is a bad option for me, given my particular circumstance, but I did send a message to Dr. Ayoola of Denton, TX, advising them of my situation and preference for the DS surgery. So hopefully later this week I'll have a better idea of what my options are, if any.