EGD/Hiatal Hernia/Exclusion on Aetna

[knmcd 34]

So frustrated! After calling True Results in Houston, I waited 2 agonizing days to hear back from them to find out if insurance would cover the procedure. DENIED! My boyfriends company has an exclusion for ANY type of bariatric surgery. Soo they asked if I have acid reflux or heartburn, which yes I've dealt with that for so long, it makes me miserable. The lady told me that there could be a way around it. If they checked me for a hiatal hernia, and if I have one, they could go in and repair it and put the lap band in at the same time. That would be a way to get insurance to cover part of it, I would just have to pay the $5500 for the band itself. I was told to come in for a free consultation and they would sit down and talk to me, get some lab work done, weight me, etc. So I went yesterday and they told me that my insurance is claiming there was a lap in coverage, which is bull, because when my boyfriend switched companies last January we made sure to get Cobra because I was 6 months prego. So I had to call and request proof of coverage to take to the Dr's office. Now I'm waiting on that paperwork, plus my lab work results to get back, so they can schedule my EGD to check me for the hiatal hernia. This will be the only way I can get the lap band!! It sounds awful to say this, but I really hope that all this heartburn and reflux is caused by a hernia!!! Yes, yes, awful I know! Don't judge me!! Has anyone gone through this?? I'm so worried that I won't be able to get the band and I'm a nervous wreck right now. I feel like I'm already hitting a ton of road blocks and I'm only 2 weeks into this journey!!

[I love lucy lover 61]

So frustrated! After calling True Results in Houston, I waited 2 agonizing days to hear back from them to find out if insurance would cover the procedure. DENIED! My boyfriends company has an exclusion for ANY type of bariatric surgery. Soo they asked if I have acid reflux or heartburn, which yes I've dealt with that for so long, it makes me miserable. The lady told me that there could be a way around it. If they checked me for a hiatal hernia, and if I have one, they could go in and repair it and put the lap band in at the same time. That would be a way to get insurance to cover part of it, I would just have to pay the $5500 for the band itself. I was told to come in for a free consultation and they would sit down and talk to me, get some lab work done, weight me, etc. So I went yesterday and they told me that my insurance is claiming there was a lap in coverage, which is bull, because when my boyfriend switched companies last January we made sure to get Cobra because I was 6 months prego. So I had to call and request proof of coverage to take to the Dr's office. Now I'm waiting on that paperwork, plus my lab work results to get back, so they can schedule my EGD to check me for the hiatal hernia. This will be the only way I can get the lap band!! It sounds awful to say this, but I really hope that all this heartburn and reflux is caused by a hernia!!! Yes, yes, awful I know! Don't judge me!! Has anyone gone through this?? I'm so worried that I won't be able to get the band and I'm a nervous wreck right now. I feel like I'm already hitting a ton of road blocks and I'm only 2 weeks into this journey!!

Yes I also have Aetna with the same exclustion for any weight loss surgery. I went thru true results had a hiatal hernia. They did fix it while the put the band in and billed Aetan. I also had to pay the difference of $5500.00 which they financed me for 2 years.

Keep up on them and good luck

[I love lucy lover 61]

So frustrated! After calling True Results in Houston, I waited 2 agonizing days to hear back from them to find out if insurance would cover the procedure. DENIED! My boyfriends company has an exclusion for ANY type of bariatric surgery. Soo they asked if I have acid reflux or heartburn, which yes I've dealt with that for so long, it makes me miserable. The lady told me that there could be a way around it. If they checked me for a hiatal hernia, and if I have one, they could go in and repair it and put the lap band in at the same time. That would be a way to get insurance to cover part of it, I would just have to pay the $5500 for the band itself. I was told to come in for a free consultation and they would sit down and talk to me, get some lab work done, weight me, etc. So I went yesterday and they told me that my insurance is claiming there was a lap in coverage, which is bull, because when my boyfriend switched companies last January we made sure to get Cobra because I was 6 months prego. So I had to call and request proof of coverage to take to the Dr's office. Now I'm waiting on that paperwork, plus my lab work results to get back, so they can schedule my EGD to check me for the hiatal hernia. This will be the only way I can get the lap band!! It sounds awful to say this, but I really hope that all this heartburn and reflux is caused by a hernia!!! Yes, yes, awful I know! Don't judge me!! Has anyone gone through this?? I'm so worried that I won't be able to get the band and I'm a nervous wreck right now. I feel like I'm already hitting a ton of road blocks and I'm only 2 weeks into this journey!!

Yes I also have Aetna with the same exclustion for any weight loss surgery. I went thru true results had a hiatal hernia. They did fix it while they put the band in and billed Aetna. I also had to pay the difference of $5500.00 which they financed me for 2 years.

Keep up on them and good luck

[knmcd 34]

Awesome, thank you and congrats to you!

[I love lucy lover 61]

ty good luck to you girl

[Rockstar_Jen 49]

I went through the exact same thing with TR. I didn't have much reflux and heartburn so I was really nervous that I wouldn't have a hiatal hernia. Thankfully I had a small one, so I am paying the 5500.00. They told me about 97% of the time a small herna is present, so try not to stress too much. In fact they even scheduled my surgery date before confirming the presence of the hernia. I did the EGD one week prior t being banded. I was banded earlier this month on the 5th. :-) I too had some guilt about wanting to have a hernia, just seems wrong... Lol

Best of luck, keep us informed

Sent from my iPad using LapBandTalk

[knmcd 34]

I know it does seem wrong! lol Thanks so much that definitely calms my nerves a bit. I have an EGD scheduled for the 6th so I'm waiting as patiently as I can. The advocate that's helping me through TR told me she didn't have any symptoms of a hiatal hernia and she had one so that helped me too! Congrats to you on getting banded, and best of luck on your journey! I'm praying I will be on my journey soon!

[browneyedgirl89 10]

Do not get the lap band!!!!!!!! I wish someone would have told me this two years ago before i was banded. It is awful. Go to vertical sleeve talk and there is a forum full of lap band patients that have switched to the sleeve

i am about to have the sleeve myself. My band has been Hell from day one!

[browneyedgirl89 10]

I should also add that i was banded at true results Houston as well

[lolarose13 147]

I'm going trough the same thing! I had my EGD today and they said to my husband (because I was asleep still haha) that I had a slightly hernia, no big deal. But I don't really know what that means! And he didn't ask about having it repair or anything. I will call TR tomorrow to find out, I have my surgery schedule for Friday and it's going to be impossible for me at this point change any budget regarding the surgery

How your surgery went?

[lolarose13 147]

An update. They just called me to let me know that the results of my EGD shows I have an hernia so they are going to fix it on friday! and that my insurance will pay for it so happy!

[knmcd 34]

Congratulations! I am still thrilled about mine! I'm down 37 pounds since my surgery on March 13th, and I feel great!

[lolarose13 147]

Congratulations! I am still thrilled about mine! I'm down 37 pounds since my surgery on March 13th' date=' and I feel great![/quote']

Wow!!!! Such a good job! Thank you for sharing, I love to hear those stories like your! Are inspiring to me

[Jennifer Toney 0]

I too am having the same procedures done...hital hernia repair so they can slap the band on the same time. But what does True Results make you pay up front? I'm concerned because I have not yet met my deductible with Aetna which is $6,000. Will I have to pay that before I get the surgery?

[The Icy One 518]

I have Aetna and went through True Results in Scottsdale, AZ for my Lap Band surgery last November. It depends on your individual plan, but no, I did not have to pay up front. I don't have co pays with my plan, so there is that... I didn't pay a dime until after my surgery and all of the bills were submitted to my insurance, negotiated, paid by them then I received the bills for my percentage. All in all, my portion was a couple of grand, give or take a few clams. Not too terrible. I would have been happy with less but I was grateful that my insurance covered the surgery and is paying for all of my aftercare.