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TIF, Nissen and Insurance

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GERD & Acid Reflux
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Posted 4/19/2012 1:41 AM (GMT 0)
My insurance company's internal appeal process is complete and they've denied my appeal to provide coverage for TIF. They are insisting that TIF is not a standard surgical care for GERD and that long term outcomes are not known and that the patient population likely to benefit from this procedure remains poorly defined. Next step for me is to get EMR (external medical review) done for my case - and I've started that process. I've heard that patients have much better luck during the external reviews - and I am hoping that the external reviewer can study my case in detail and will be able to understand the uniqueness of my situation. If however, even that external review fails, I can file a lawsuit. However, I am not sure how long can I wait ...

I am considering all my options in the case I exhaust all the steps of this appeal process:
- Pay for TIF (approx. $14K)
- Get Nissen done (will be fully covered by the insurance)
- (No, I don't want to go for LINX even though it might be cheaper - $12K and it may not really be cheaper since I will have to fly to other cities multiple times).

My surgeon thinks I can benefit from either Nissen or TIF and the side effects from Nissen are not that common and that I should not assume I will have them.

Thoughts - comments?

Thanks
Posted 4/19/2012 2:50 AM (GMT 0)
Why are you against the LINX? For me, that will be first choice as it is much less altering than either the TIF or Nissen and can be easily reversed, unlike the others. My 2nd choice would be the TIF, but I do not like the fact that is not reversible (completely). Nissen would be my last choice and ONLY IF I had a surgeon that has done over 2,000 (Dr Luketich, for example, in PA has done or overseen over 4,000 supposedly).
Posted 4/19/2012 3:10 AM (GMT 0)
Re: Linx
I don't like the fact that there will be a foreign object sitting on the soft tissue of my esophagus - basically forever. Since there is no long term data on this .. we don't really know if this device will not migrate, not cause erosions or not cause harm to the vagus nerve under which it goes in. Plus, there are patients on this forum who have experienced (or are experiencing) esophageal spasms. Others complain of not being able to swallow properly. Further - I don't consider having to go through another surgery as 'easily reversible' - and there is also that 'no MRI' that bothers me.

However, more importantly - my GERD is not that severe .. but bothers me constantly since I can not take medications. LINX I feel is a solution that one should use when one's GERD is on the severe end of the spectrum.
Posted 4/19/2012 11:48 AM (GMT 0)
Actually I respectfully disagree as LINX is going to be considered as an interval between PPi's and Nissen. Also, you can easily get vagal irritation and swallowing issues/spasms with Nissen and TIF, and perhaps even a higher chance with the two. I dunno, I guess we see it completely differently as I feel LINX is MUCH less invasive than Nissen, and still does less "realignment" than TIF.....
Posted 4/19/2012 2:11 PM (GMT 0)
what about the stretta procedure??
Posted 4/19/2012 4:16 PM (GMT 0)
I don't believe they do to many stretta procedures in the states any more. If I remember correctly creating scar tissue to solve a weak LES may not of had the best results. You may end up with swallowing problems from the procedure. Hopefully some one else here has more info. for you.

Doggbones
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