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WLS excluded, but Hernia repair covered

eLinor

By eLinor, in Insurance & Financing

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eLinor    12

eLinor
Posted

Hello! I am 37, in Dallas. 5'5" 200lb. My husband is a Teamster and we have excellent coverage thru BCBS of Illinois....BUT...all WLS are deemed cosmetic and are excluded. Here's my question: I have a documented hiatal hernia, been on dexilant for the past year. My insurance will cover hernia repair at 100%. I am thinking it should not be the entire self pay price to get sleeved along with hernia repair. Has anyone else had a similar situation?

~ L Nor in TX

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Molly3    495

Molly3
Posted

Very same situation right here & have been wondering about this question all weekend!! I'm calling my surgeons office today to find out.

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LiggleLiggle    84

LiggleLiggle
Posted

I had a hernia repair which required band removal and the doctor gave me a fantastic deal on the sleeve as my insurance didn't cover WLS. They did cover band removal and hernia repair. I feel so blessed and I tell my dr that every time I see him!

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eLinor    12

eLinor
Posted

I have a message into the surgeon who did my dad's sleeve & will do my nor'easter next week. Initially, via email, his Billing dept. quoted me $12,500. (that is the self pay price for anyone) Surely it will be less seeing how the extremely similar surgery & everything associated with it (hernia repair) is already covered. Crossing fingers!

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eLinor    12

eLinor
Posted

I meant to type "mom's"

Not whatever that crazy word is....auto correct!

~ L Nor in TX

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carstanger    346

carstanger
Posted

I had hiatal hernia repaired, gall bladder removed, scar tissue removed along with my sleeve. He didn't bill for the sleeve so most of the hospital was covered.

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eLinor    12

eLinor
Posted

Carol,

Where is this surgeon?

~ L Nor in TX

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Museum-Mama    196

Museum-Mama
Posted

eLinor,

I am using My Bariatric Solutions, and have the same insurance issues. They quoted me, with 80% repair covered by insurance and self-pay on the sleeve, it was just something over $7000! :)

Otherwise, for both things, I am looking at over $12,000 out of pocket costs.

I highly recommend MBS. They have been nothing but awesome! I used the Dallas Office for my consultation, and then all surgeries are done at Decatur.

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eLinor    12

eLinor
Posted

Thanks, Museum-Mama

I am really hoping Dr. Kuhn's office calls me back with a price more like that. Mexico would be $4700, plus airfare (Dr. Garcia) but I would rather stay here in Dallas.

~ L Nor in TX

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carstanger    346

carstanger
Posted

Muskegon Mi.. Long way from Tx

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eLinor    12

eLinor
Posted

Yeah! Mexico is closer..lol!

~ L Nor in TX

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eLinor    12

eLinor
Posted

Well..my surgeon's office called and said it would be $4500 for his few and $7500 for the hospital's fee. I don't get it! Maybe some of you healthcare professionals could explain. My insurance company will already be paying for OR, anesthesia, etc. associated with Hernia repair. How can it be so much more to add the sleeve?

~ L Nor in TX

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eLinor    12

eLinor
Posted

My goodness!! I need to turn this auto correct off!!

Fee, not few!

~ L Nor in TX

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eLinor    12

eLinor
Posted

Yes, he is! I just got home from.Baylor. Dr. Kuhn operated on my mom this morning. Sleeve & hernia repair. He is so great!!

~ L Nor in TX

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