Hernia and sleeve insurance question

[%#LoosingIt?!&- 16]

Question on the haitial hernias and sleeves. I would be traveling for sleeve surgery out of state but within the U.S. (would be cash pay bc insurance excludes WLS). I am praying for hernia to be confirmed so I could have that repaired and just pay a smaller portion out of pocket for the sleeve and have insurance pay for hernia repair. Here's the question-- How do I go about getting hernia confirmed? Since I'm out of state and won't see the sleeve Dr until I know if I am a candidate because I won't be able to afford it without the hernia. I just made an apt with a local Gastrointestinal Dr. Would they look at me like I'm a freak and refuse to do an endo if I tell them the truth that 'I just need hernia confirmed before wls'? Or what do I say?

[CanyonBaby 1,852]

I think if it was me, I would call up the surgeon you have selected for WLS, and ask about it. I would ask if A.) they base the surgery on the hernia first, then do WLS as a secondary surgery, because anesthesia ... might be covered that way (this is, of course, after you have been already diagnosed with a hernia). I would then ask B.) if they have a payment plan to cover you in case you don't have a hernia.

My hernia was a surprise I didn't know about until after I woke up from the surgery. I was a self-pay patient, but my insurance did pick up the hernia repair.

I understand you want to be diagnosed with the hernia first, before doing anything more, so maybe go to your primary care physician and ask how to get it diagnosed, if they suspect you do have one. You might ask if they would confer with your selected surgeon to plan out your surgery.

This may get very confusing for them, so be specific about what you need, what you can afford, where this is to take place, and when, and in what order it should be done in. And again, ask about payment plans...it may be very beneficial for you! Good luck to you, and let us know how it works out!

[Slim-Shady 79]

The center who performed my surgery looked for that automatically. I guess I thought they all did. I was told that almost everyone has it, and that the insurance companies have to repair it. If possible, I would use a bariatric center who knows all of the insurance ins and outs to ensure your insurance covers as much as possible. In my case, I went to my initial consultation, and found out that day that my insurance did not cover WLS. They told me what my out of pocket expense would be if I had/didn't have a hiatal hernia. They scheduled an EGD (which the insurance company had to cover as well), and they confirmed the hernia. They provide pictures as proof for the insurance company and that was that! My surgery was scheduled, and I knew what my out of pocket costs would be. They also had a payment plan available no matter your credit. They repair the hernia, and perform the WLS at the same time. That's how they get around non-coverage.