Self pay and hiatal hernia

[AtlantaRed 651]

Hi everyone,

I will be self pay for the sleeve. I've had heartburn off an off for years but definitely moreso since last year after having my gallbladder removed. Met with the surgeon today who mentioned that if I had a hiatal hernia, he would fix it while doing the sleeve.

I'm wondering, does anyone know if I could possibly get part of the surgery covered under the guise of having the hiatal hernia repaired?? Could I get the hospital stay, anesthesia, etc covered as necessary for the hiatal hernia?

Thanks for any input!

[ScottsGirl 106]

Why won't your insurance pay for the sleeve???

[RickM 1,753]

There is a good possibility that you could get a major part of the cost covered for repairing the hiatal hernia, with you covering whatever added cost is involved (additional OR time, probable extra day in hospital, etc.) This is done all the time in getting tummy tucks and similar reconstruction surgeries partially paid for by way of repairing umbilical or incisional hernias.

[AtlantaRed 651]

My husband's company didn't choose to have that covered in their insurance plan.

[AtlantaRed 651]

There is a good possibility that you could get a major part of the cost covered for repairing the hiatal hernia, with you covering whatever added cost is involved (additional OR time, probable extra day in hospital, etc.) This is done all the time in getting tummy tucks and similar reconstruction surgeries partially paid for by way of repairing umbilical or incisional hernias.

Who would I ask about that? Would I contact the coordinator at the Surgical Center? I guess they would know the ways of getting around that?

[LaLa K 7]

I too have a hernia and I am self pay. My surgery is day after tomorrow and my hernia will be prepared at this time. My surgeon is charging me the cash price for sleeve surgery and billing my insurance for the hernia repair which will be paid in full by my insurance. Even though they are being done at the same time it is billed like a separate procedure. Hope this helps you some!

[ScottsGirl 106]

My husband's company didn't choose to have that covered in their insurance plan.

Sorry to hear that! I would call the surgical center as you are right, they would know the exact coding to use to get the majority covered.

[AtlantaRed 651]

I too have a hernia and I am self pay. My surgery is day after tomorrow and my hernia will be prepared at this time. My surgeon is charging me the cash price for sleeve surgery and billing my insurance for the hernia repair which will be paid in full by my insurance. Even though they are being done at the same time it is billed like a separate procedure. Hope this helps you some!

Thanks! My surgeon actually said he would repair the hernia (if present) for free, included in the sleeve cost. I was just wondering if I could get insurance to pay for the anesthesia, overnight stay, etc. Something else to look into, I guess!

[LaLa K 7]

They are going to take your cash ASAP!! The hernia repair should be included but my doctor is billing insurance for a little time, anesthesia, etc to get some money from them for the hernia repair.

[nsquared 232]

I had surgery in Feb 2013 and my situation was exactly like LaLa K above. The endoscopy and hernia repair was billed to my insurance. I paid cash for the sleeve.

[AtlantaRed 651]

They are going to take your cash ASAP!! The hernia repair should be included but my doctor is billing insurance for a little time, anesthesia, etc to get some money from them for the hernia repair.

I had surgery in Feb 2013 and my situation was exactly like LaLa K above. The endoscopy and hernia repair was billed to my insurance. I paid cash for the sleeve.

Thanks so much! So, maybe I'm getting a good deal with him doing the hernia repair for free.

[LaLa K 7]

From what I understand if they find a hernia it MUST be repaired in order to do the sleeve. I just happened to know I have one from an endoscopy done 5 or 6 years ago. Clear Liquids for me tomorrow and I am so ready for Thursday!! Good luck to you!!

[AtlantaRed 651]

From what I understand if they find a hernia it MUST be repaired in order to do the sleeve. I just happened to know I have one from an endoscopy done 5 or 6 years ago. Clear liquids for me tomorrow and I am so ready for Thursday!! Good luck to you!!

Good luck to you!!!

My hernia is not confirmed yet but I will have an upper GI before the surgery, so he will know going in!

Congrats and hope you have a smooth recovery!

[RickM 1,753]

Who would I ask about that? Would I contact the coordinator at the Surgical Center? I guess they would know the ways of getting around that?

Yeah, the insurance coordinator for your doc or the surgical center would be the place to start. It may take your suggesting to them that you pay them their standard self pay price for the sleeve and hernia and they rebate you whatever the insurance pays for the hernia repair. The plastics guys are used to doing this as their work is largely self paid but the bariatric guys don't do these deals as often. I paid upfront for my reconstruction surgery, and I will eventually get about half of it back from the hernia repairs that were done at the same time.

Good luck in getting something out of all of this!

[Mel1071 149]

I just saw another thread where a self pay patient's price of almost $12K was being reduced to 6K because of hernia. I guess I should contact my doctor's office to see how they plan on handling things if a hernia is found.