Re: vigorous vs. tolerable (Debbi)

[Guest guest]

Hi Debbi,

This definitely helped me. I wasn't for sure if it was medical or not.

I guess I am at the stage between tolerable and intolerable, I mean

some days I can deal with it beter than others. People around you

waiting to make sure your food went down, it's not embarrassing but

its something that is annoying.

The doctor I was supposed to see on Monday, was not familiar

with " A " . So off I go to call my insurance agency to see what to do.

Thank you so much for your help and advice. Everyone has been such a

help.

Genia

> Genia, there is no " real " definition of " tolerable achalasia " --

it's just an arbitrary term that people use, not a medical term at

all. Tolerable achalasia to one person may be intolerable achalasia

to another, it just depends on what that person's tolerance level

is! Some people are happy w/ only drinking nutrition shakes and

never eating real food again -- that is tolerable for them. Some

people want to eat ANY kind of food w/o having to worry about

regurging in the middle of a restaurant, etc., so for them being

restricted to a diet of liquids and/or mush would NOT be tolerable.

>

> As for " vigorous " achalasia, it's a very misleading term in my

opinion, although it is truly a medical term. Vigorous achalasia

refers to simultaneous contractions in the body of the esophagus

itself (the contractions are generally stronger than a regular/normal

peristaltic contractio would be), along with the classic Achalasia

symptom of the failure of the LES to relax upon swallowing.

>

> I don't like the choice of the word: vigorous. I think it makes

it sound like the LES itself is different in vigorous achalasia

compared to classic achalasia, and that's not the case. I think it

would make more sense to categorize the symptoms that are/aren't

present:

>

> achalasia without any esophageal contractions

> achalasia with peristaltic esophageal contractions

> achalasia with mild/ineffective esophageal contractions (non-

simultaneous)

> achalasia with mild simultaneous esophageal contractions

> achalasia with strong simultaneous esophageal contractions

>

> Depending on who you listen to, Vigorous Achalasia will be

diagnosed if you have simultaneous contractions that are either

regular-strength or super-strength. Other docs will only diagnose

Vigorous Achalasia if the simulateous contractions are super-

strength, but not just for regular-strength contractions.

>

> Hope this helps!

>

> Debbi

[Guest guest]

Genia, glad to have helped.

What insurance do you have now? (I recall you were switching...)

I know that The Cleveland Clinic participates with BCBSM -- if you have PPO or POS or BCN through Blue Cross, as long as you get a referral you *should* be able to go to TCC for the same price as anyone in Detroit. Lemme know if you need any help w/ this -- I have some contacts who might be able to help you if you want to go that route.

Deb

[Guest guest]

Hi Debbi,

My new insurance is Total Health Care. BCBS was going to be very

expensive for my family so we went with this one.

It usually takes me a couple of months to see how my insurance

works , if it is a new one.

I did get a hold of Cleveland Clinic, and they said they basically

accept any insurance. I just have to see what they are going to

cover. My plans are to call them on Thursday or Friday to see what I

need to do, The chairman of Surgeons at the hospital I am assigned to

does not do a heller.

I accept any help that you may give!!!

Thank you very much.

Genia

> Genia, glad to have helped.

>

> What insurance do you have now? (I recall you were switching...)

>

> I know that The Cleveland Clinic participates with BCBSM -- if you

have PPO or POS or BCN through Blue Cross, as long as you get a

referral you *should* be able to go to TCC for the same price as

anyone in Detroit. Lemme know if you need any help w/ this -- I have

some contacts who might be able to help you if you want to go that

route.

>

> Deb

[Guest guest]

Hey Genia --- I'm not familiar with Total, but I'll help as much as I can.

One important thing to clarify is not ACCEPTANCE of a particular insurance, but rather PARTICIPATION in the program.

Example:Doctor 1 ACCEPTS Insurance X but does not participate. Doctor 2 actually PARTICIPATES with Insurance X.

If #1 bills $100 for an office visit, but your insurance only approves $40 for that charge (not taking into account any deductibles or co-pays), then #1 "accepts" the $40 from the insurance but then YOU are responsible for the other $60 of the bill.

If #2 bills $100 for an office visit, but your insurance only approves $40 for that charge (not taking into account any deductibles or co-pays), then #2 "participates" by taking the $40 from the insurance and then WRITING OFF the other $60 of the bill.

I would call your insurance company and ask if TCC PARTICIPATES in their plan, and also if it's ok for you to get treatment out of the state. Then also ask if you have to have a "referral" from your primary doctor in order to go to a specialist.

If you need a referral, get one from your main doc for you to go to TCC. If you don't need a referral for it to be covered, then just call TCC and make your own appt.

Personally, unless your insurance requires it for some reason, I wouldn't bother seeing a GI specialist in Detroit -- I'd just go straight to TCC. They see HUNDREDS of achalasia cases each year -- you're not gonna find ANYONE in Detroit w/ numbers like that.

Lemme know if there's anything I can help with, and feel free to email me off-list if you want, too. I'll help any way I can!

Deb