Heartburn Support - Upper GI results

Author

Upper GI results

Blocks to Books

2006-09-30, 9:25 pm

Can an upper GI barium series that shows no hiatal hernia be counted on as
definitive as to whether a person actually has a hiatal hernia or not? My
upper GI came back showing I had no hiatal hernia. Does it ever happen that
a hiatal hernia is found later during an endoscopy and not found on the GI
series?

Unfortunately the surgeon who ordered the GI barium test does not want to
continue with any more testing on me because I only want to be worked up to
see if I am a good Stretta candidate and get a Stretta procedure if I am a
good candidate. He really believes in the fundo even though I said it was
not something I was comfortable with at this time. Unfortunately he is the
only Stretta trained physician who is a participating provider on my health
insurance in my area. As a result of this, I now I have a pre-existing
condition if I change insurance providers that will prevent coverage on any
reflux related items for a year or would prevent coverage on a Stretta
procedure also. Otherwise I would change my insurance coverage to one that
has more Stretta trained doctors as participating providers. I'm going to
try to get the rest of the testing done through a participating provider ENT
or gastroenterologist to see if I am a valid Stretta candidate or not. I
hope I will find a doctor who will be willing to do these tests on me. With
my history of long standing lpr, I'd like to at least have them done to see
the status of my esophagus, etc. even if turns out I'm not a good Stretta
candidate.

However, I may, in fact, be a very good Stretta candidate. My current
insurance company wouldn't have covered it (Aetna), but they will cover
necessary testing. I don't know if it's possible, but I hope Curon will be
doing training or studies in my area so I can sign up to possibly get the
work up and procedure as part of a study or teaching seminar for doctors if
I am a good candidate physically for Stretta. If not, it would save me some
money if I had to go out of pocket for the procedure if I was a good
candidate. I have no idea what it costs because I've not been able to find
anyone who will quote me a ball-park estimated price they charge for the
procedure.

I know there are many more criteria that would either rule me out or rule me
in as a good Stretta candidate, but the GI series came back very good with
no swallowing defects or masses, etc. I did burp by accident when I took
the air producing crystals. Don't know if that could drastically affect the
results or not but so far I have hope that I wasn't ruled out as a good
candidate on the first test.-Blocks to Books

Howard McCollister

2006-09-30, 9:25 pm

"Blocks to Books" <news@blockstobooks.com> wrote in message
news:lBBTg.545$rS.123@fed1read05...
> Can an upper GI barium series that shows no hiatal hernia be counted on as
> definitive as to whether a person actually has a hiatal hernia or not? My
> upper GI came back showing I had no hiatal hernia. Does it ever happen
> that a hiatal hernia is found later during an endoscopy and not found on
> the GI series?

Sure. That happens frequently. Upper GI is the bluntest of tools for such
diagnosis.

> As a result of this, I now I have a pre-existing condition if I change
> insurance providers that will prevent coverage on any reflux related items
> for a year or would prevent coverage on a Stretta procedure also.
> Otherwise I would change my insurance coverage to one that has more
> Stretta trained doctors as participating providers.

Pre-existing conditions apply to individually purchased policies. If you
insurance is a group policy through your work or your spouse's, pre-existing
conditions only disqualify you through the initial exclusion period --
usually 30-90 days.

> I don't know if it's possible, but I hope Curon will be doing training or
> studies in my area so I can sign up to possibly get the work up and
> procedure as part of a study or teaching seminar for doctors if I am a
> good candidate physically for Stretta. If not, it would save me some
> money if I had to go out of pocket for the procedure if I was a good
> candidate.

Sort of like getting cheap haircuts at a barber college?

It doesn't work
that way...sorry.

> I know there are many more criteria that would either rule me out or rule
> me in as a good Stretta candidate, but the GI series came back very good
> with no swallowing defects or masses, etc.

Again, I'm sorry....I hope you're right, but...UGI ...blunt tool...etc etc.

HMc

Blocks to Books

2006-09-30, 9:25 pm

"Howard McCollister" <nospam@nospam.net> wrote in message
news:451efa86$0$37643$bb4e3ad8@newscene.com...
>
> "Blocks to Books" <news@blockstobooks.com> wrote in message
> news:lBBTg.545$rS.123@fed1read05...
>
>
> Sure. That happens frequently. Upper GI is the bluntest of tools for such
> diagnosis.
>
>
>
> Pre-existing conditions apply to individually purchased policies. If you
> insurance is a group policy through your work or your spouse's,
> pre-existing conditions only disqualify you through the initial exclusion
> period -- usually 30-90 days.
>
>
>
> Sort of like getting cheap haircuts at a barber college?

It doesn't
> work that way...sorry.
>
>
>
> Again, I'm sorry....I hope you're right, but...UGI ...blunt tool...etc
> etc.
>
>
>
> HMc
>
>
>

Unfortunately I am individually insured and not insured through a group such
as through a group work insurance. My insurance agent told me one year is
the norm for individual insurance policies for pre-existing conditions.

Thanks very much for the info on the upper GI. I'm not feeling so deprived
of the other testing now because I realize that UGI is basically not much
more than a good indication of the fact I have an esophagus and it's firmly
connected to my stomach with no huge masses or growths. I was hoping it was
definitive at least for hiatal hernia so I was feeling really hopeful and
very anxious to get on with further testing if it was.

As far as haircuts in a barber college, unfortunately when people get
desperate, they sometimes consider stupid and desperate measures. I was
hoping Stretta had some kind of clinical trials, etc. Trying to find a
doctor that will take me on based on the testing of some other physician
might be difficult and none of the Stretta doctors are on my insurance. I
have an extremely high deductible and the way they determine deductible
being met is what other doctors accept as payment by the insurance, not what
the doctor will bill a patient like myself who is paying top price out of
pocket. I have no idea what a Stretta costs - under or over 10,000, so I
don't know if I can afford it out of pocket or not. It will have to be out
of pocket if it's done in the next year or another year if I change to an
insurance that covers it or has more physicians as preferred providers. It
will be hard thinking I have to suffer for another year, but if I do, I do.
I know I couldn't afford both the testing I need and the Stretta out of
pocket so I hope I can get the testing covered by insurance and that the
Stretta doctor will accept the test results as valid even though not done by
him or her. Anyway, thanks again very much for the info. I appreciate it so
much.
-Blocks

Howard McCollister

2006-10-01, 2:26 am

"Blocks to Books" <news@blockstobooks.com> wrote in message
news:9CDTg.549$rS.239@fed1read05...

> Thanks very much for the info on the upper GI. I'm not feeling so
> deprived of the other testing now because I realize that UGI is basically
> not much more than a good indication of the fact I have an esophagus and
> it's firmly connected to my stomach with no huge masses or growths. I was
> hoping it was definitive at least for hiatal hernia so I was feeling
> really hopeful and very anxious to get on with further testing if it was.

LOL. That's pretty much it in a nutshell. Sorry, it's not definitive, only
suggestive.

> As far as haircuts in a barber college, unfortunately when people get
> desperate, they sometimes consider stupid and desperate measures. I was
> hoping Stretta had some kind of clinical trials, etc. Trying to find a
> doctor that will take me on based on the testing of some other physician
> might be difficult and none of the Stretta doctors are on my insurance. I
> have an extremely high deductible and the way they determine deductible
> being met is what other doctors accept as payment by the insurance, not
> what the doctor will bill a patient like myself who is paying top price
> out of pocket.

Stretta's clinical trials are long done with. Device's like this - about the
only way to hope to get it paid for, or even discounted, is to have it done
as part of the initial human trials that come after the very basic research.
After they've done the dogs. Depending on the conditions of any grant money,
usually the FDA trials are paid for too. After FDA approval, there are
sometimes grants that fund additional clinical trials to prove efficacy, but
those are all long done with for Stretta.

For a physician to learn Stretta, he/she first has to attend a training
course at one of a few centers across the country. I was at Vanderbilt for a
couple of days and it cost me about $4500, not counting those two days out
of my practice which cost me a lot more than $4500. Then, committing to
buying the equipment and catheters, I scheduled 4 patients on a day and
Curon sent a clinical rep (RN) to inservice the OR staff and assist me with
those first cases. If that rep found that I did those procedures OK, then
they let us have the catheters and we were good to go. Those first 4
patients (their insurance companies) paid the standard charge - hospital
plus my fee.

There are no additional training courses, and they don't take the show on
the road. If Curon were insevicing a new physician in your area and you were
part of his initial patient group, you'd still pay.

It's worth noting that Stretta seems to be in the doldrums as far as use
goes, and very few new doctors are learning it. This is partly because its
efficacy is only mediocre, and partly because the RVUs that are assigned to
it are such that reimbursement barely covers the cost of the equipment and
the disposable catheter. It has become cost prohibitive for almost all
hospitals and physicians. Hospitals actually lose money on each one,
physcians get reimbursed so poorly that there's no way a physician can
justify spending that hour doing a procedure that will only return about
$150. Indicative of the downturn in the Stretta is that Dr. David Utley, the
actual inventor of the procedure, left Curon about a year ago, as did
several of their key marketing people. I learned this in a recent
conversation with the guy who used to be our Curon rep. He's now working
with Barrx Medical ( http://www.barrx.com/ ) selling a device that actually
ablates the dangerous tissue of Barrett's esophagus (HALO 360). Very
promising and that device was invented by - Dr. David Utley. We've just
started using that device at our institution.

The poor reimbursement is likely one reason why the surgeon you saw wasn't
particularly interested in Stretta, but I do agree with him that
fundoplication is a substantially superior anti-reflux procedure.

HMc

Blocks to Books

2006-10-01, 9:28 pm

"Howard McCollister" <nospam@nospam.net> wrote in message
news:451f2b99$0$37677$bb4e3ad8@newscene.com...
>
> "Blocks to Books" <news@blockstobooks.com> wrote in message
> news:9CDTg.549$rS.239@fed1read05...
>
>
>
> LOL. That's pretty much it in a nutshell. Sorry, it's not definitive, only
> suggestive.
>
>
>
>
>
> Stretta's clinical trials are long done with. Device's like this - about
> the only way to hope to get it paid for, or even discounted, is to have it
> done as part of the initial human trials that come after the very basic
> research. After they've done the dogs. Depending on the conditions of any
> grant money, usually the FDA trials are paid for too. After FDA approval,
> there are sometimes grants that fund additional clinical trials to prove
> efficacy, but those are all long done with for Stretta.
>
> For a physician to learn Stretta, he/she first has to attend a training
> course at one of a few centers across the country. I was at Vanderbilt for
> a couple of days and it cost me about $4500, not counting those two days
> out of my practice which cost me a lot more than $4500. Then, committing
> to buying the equipment and catheters, I scheduled 4 patients on a day and
> Curon sent a clinical rep (RN) to inservice the OR staff and assist me
> with those first cases. If that rep found that I did those procedures OK,
> then they let us have the catheters and we were good to go. Those first 4
> patients (their insurance companies) paid the standard charge - hospital
> plus my fee.
>
> There are no additional training courses, and they don't take the show on
> the road. If Curon were insevicing a new physician in your area and you
> were part of his initial patient group, you'd still pay.
>
> It's worth noting that Stretta seems to be in the doldrums as far as use
> goes, and very few new doctors are learning it. This is partly because its
> efficacy is only mediocre, and partly because the RVUs that are assigned
> to it are such that reimbursement barely covers the cost of the equipment
> and the disposable catheter. It has become cost prohibitive for almost all
> hospitals and physicians. Hospitals actually lose money on each one,
> physcians get reimbursed so poorly that there's no way a physician can
> justify spending that hour doing a procedure that will only return about
> $150. Indicative of the downturn in the Stretta is that Dr. David Utley,
> the actual inventor of the procedure, left Curon about a year ago, as did
> several of their key marketing people. I learned this in a recent
> conversation with the guy who used to be our Curon rep. He's now working
> with Barrx Medical ( http://www.barrx.com/ ) selling a device that
> actually ablates the dangerous tissue of Barrett's esophagus (HALO 360).
> Very promising and that device was invented by - Dr. David Utley. We've
> just started using that device at our institution.
>
> The poor reimbursement is likely one reason why the surgeon you saw wasn't
> particularly interested in Stretta, but I do agree with him that
> fundoplication is a substantially superior anti-reflux procedure.
>
> HMc
>
>
>

Thanks so much for this info. It makes me feel so much better to know these
things. I really appreciate being able to better understand about the
surgeon's very understandable lack of interest in doing a Stretta. Medicine
is a business as well as a practice and, as a business, it must run on sound
business principles. If only the surgeon or his assistant would have told
me this - especially before I made the first appointment with his medical
assistant, I could have accepted it and understood completely. My confusion
and resentment over the whole situation is gone thanks to you.

Since I still believe my extreme fitness lifestyle is not compatible with
maintaining a successful fundoplication, I will try to live with the lpr but
will have esophagus scoped occasionally to make sure I'm not developing
Barretts.

Who know, maybe someday a valid procedure that is done internally from
inside the sphincter will come along that is valid and properly reimbursed
that I can make use of so I can have a more normal life. God bless you for
telling me what you did. It has helped me so much. I can't express how
much better I feel. -Blocks