Insurance will cover hiatal hernia repair but not GS?

MaraFaith
on 10/15/14 11:57 am - denham springs, LA

Due to severe GERD symptoms , I will possibly need hiatal hernia repair. I was looking into gastric sleeve to be preformed at the same time, but my insurance has an exclusion for weightloss surgery, so the gastric sleeve would have to be self pay.

Has anyone had this done? I've heard of it greatly reducing the price of the sleeve when the hernia repair is paid for by insurance, but I definitely need help finding out how to go about this. Can anyone share their exprience? Thanks in advance! My appointment with the surgeon is 10/30 and I need to know what to ask.

lfenix
on 10/16/14 1:42 am
VSG on 10/27/14 with

My insurance has a bariatric surgery exclusion, too, but it is covering all but $3500 of the surgery for me because I have the hiatal hernia.  The clinic I'm going through (True Results) has processed everything for me, and all I owe is the $3,500 plus the $1,500 deductible.  Total out of pocket for me will be $5,000, but I had the $1,500 deductible saved in an HSA, so technically, just the $3,500.  

Apparently the WLS doctors figured out this little insurance end-around and many of them are offering to do it.  Several clinics will offer a special deal like this, so just shop around.  Actually, I was at one surgeon's office, and they told me to go look for someone still offering the $4995 hiatal hernia deal, because they had just stopped offering it the day before I went in.  I was ready to self pay up to $12k for this to be done, but this woman at the other surgeon's office told me how they did it, and I called True Results, because they were advertising the $4995 deal.  She told me 98% of obese people have the hiatal hernia, so it's not a big risk.  You just have to have the EGD to identify it, which insurance pays for.  

If you have severe GERD, you most definitely will have one.  I have had mild GERD, and I had one.  It's no big deal.  You'll see, the surgeon's office has done this a lot, so they will know exactly how to handle your insurance.  

54, Height 5'2", HW 229 PreOp Diet SW 220  Surg W 214 (10/27/14) GW 135 CW 192

        

  

MaraFaith
on 10/16/14 3:40 am - denham springs, LA

Thank you so much Ifenix. I've been stressing so badly over this, but I'm determined to get the sleeve, even if I have to go to Mexico.  My EGD is scheduled for Monday, and I hope to have WLS before the first of the year when our insurance changes their plan (Yikes!). Hopefully I can keep the same doctor I had for my gallbladder removal, but I'll definitely shop around.

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