Hernia/VSG self pay

JLMiller823
on 1/29/18 12:24 pm

Has anyone had any success getting their insurance to cover their Hiatal Hernia surgery and then just paying the doc an add on fee for the VSG? I thought I had read somewhere that people have had success with that, but now I can't seem to locate it.

My Aetna insurance does NOT cover any weight loss surgery. I'll be self pay. I have a hiatal hernia and would love to have the cost of WLS reduced by insurance covering some of the costs.

Knitter215
on 1/31/18 11:03 am
VSG on 08/23/16

That is going to depend on your surgeon. What you want to find is someone who is on Aetna's approved list to do the hiatal hernia that also does bariatric surgery. Once you have found a doctor or doctors who meet that criteria - call the office and ask to speak with someone about whether the doctor combines procedures and takes self payment. Most will, but its really up to the surgeon. I know that the doctor I'm seeing about plastics does - my carrier will cover the tummy but will not cover my arms - he's laid out what my cost would be to "add on" my arms when I have my tummy done.

Keep on losing!

Diana

HW 271.5 (April 2016) SW 246.9 (8/23/16) CW 158 (5/2/18)

monalissanne
on 2/6/18 11:01 am
VSG on 01/15/18

I did. I have Blue Cross (Texas) which does cover VSG typically, but my employer excludes it. I had two hiatal hernias repaired. When I met with my surgeon two price lists were presented to me - one if my endoscopy showed a hernia, one if it didn't. Then my insurance approved the hernia repair which in turn made some of the other items on my things to pay for a little cheaper. Had I not had a hernia(s), it would have been more expensive. That being said, the difference with the partially covered was minimal in my opinion. I think it was about 3-4k less; however, in the end including pre-op appointments and other requirements, I still paid close to 12k. My surgeon was Brian Mirza in Houston, TX, and I went to him because of his resume, and I personally knew someone who operated on. Other popular surgeons in the Houston, lower east Texas area were 15-16k and my questions about partial insurance coverage were answered as if I was doing something fraudulent.

I highly recommend Dr. Mirza. He has never had a patient with a leak, injury, or death. He is cautious to the point of annoyance, but it is in the patient's best interest. He also gives out his personal cell phone and returns calls immediately. He cares and is very accessible.

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