Member Comments are provided by individuals and reflect their personal opinions only. Under NO circumstances should you act on any advice or opinion posted in this forum. ALWAYS check with your personal physician before taking any action regarding your health! MedHelp International and our partners, sponsors and affiliates have no obligation to monitor any comments posted on this site, or the content and/or accuracy of such exchanges. MedHelp International does not endorse the views of any user.
Gastroenterology (Expert Forum)
gastroparesis
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
gastroparesis
by littlesister53, Nov 20, 2005 12:00AM
Seeking information on overturning insurance denial for Enterra implant for severe gastroparesis. Current ins. co. denied coverage claiming treatment is "experimental."
Documented research shows Enterra implant has FDA approval, and is third generation in development. Also, FDA has designated implant treatment as "Humanitarian Use Device" and therefore is covered by some. HUD designation indicates that mfg. receives govt. funds for development & distribution because medical need is less than 4,000 nationwide and/or patients unable to pay.
Insurance refuses to pay; private pay in excess of $100,000 which we DON'T HAVE.
Willing to contact anybody, any where. Governor, Representatives, Senators, Insurance Commissioner, State Attorney General, Social Security Office (local, regional, state, federal); need names, phone numbers, addresses, and/or e-mail of ANYBODY that can help.
Specific need is contact companies, advocates, documentation of where ins. co. have approved coverages of Enterra; anything of use to obtain this medical care.
We are in the last stages of this illness, and if unable to obtain this medical care, we will litterally starve to death. She is 5'6" and weighs less than 100 pounds; all medications have been tried with little success. Current treatment is with feeding tube (temporary at best).
She is not eligible for Medicare or Medicade; does not qualify for disability (30 month waiting period); does not have this time frame.
Please help me! Thank you for any help.
Documented research shows Enterra implant has FDA approval, and is third generation in development. Also, FDA has designated implant treatment as "Humanitarian Use Device" and therefore is covered by some. HUD designation indicates that mfg. receives govt. funds for development & distribution because medical need is less than 4,000 nationwide and/or patients unable to pay.
Insurance refuses to pay; private pay in excess of $100,000 which we DON'T HAVE.
Willing to contact anybody, any where. Governor, Representatives, Senators, Insurance Commissioner, State Attorney General, Social Security Office (local, regional, state, federal); need names, phone numbers, addresses, and/or e-mail of ANYBODY that can help.
Specific need is contact companies, advocates, documentation of where ins. co. have approved coverages of Enterra; anything of use to obtain this medical care.
We are in the last stages of this illness, and if unable to obtain this medical care, we will litterally starve to death. She is 5'6" and weighs less than 100 pounds; all medications have been tried with little success. Current treatment is with feeding tube (temporary at best).
She is not eligible for Medicare or Medicade; does not qualify for disability (30 month waiting period); does not have this time frame.
Please help me! Thank you for any help.
Doctor's Answer
by Kevin Pho, MD, Nov 21, 2005 12:00AM
, Nov 21, 2005 12:00AM
You are correct that the Enterra device has received FDA approval as a humanitarian use device. Studies have shown that this device reduces nausea and other symptoms in refractory cases of gastroparesis. However, the data is preliminary and more studies need to be done to validate its efficacy.
I cannot speak for the insurance company as to why they denied this.
You can consider appealing this decision with help from the primary care physician or gastroenterologist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_b
I cannot speak for the insurance company as to why they denied this.
You can consider appealing this decision with help from the primary care physician or gastroenterologist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_b
