Hiatal Hernia Route? Dr. Nicholson

[iwant2becurvynotlumpy 1]

I've called and scheduled a consult with Dr. Nicholson in Plano, Tx. While I was on the phone the lady scheduling it said you are going the hiatal hernia route. When I asked her what that meant she said the lady with insurance would go over that with me. Anyone know what this means? I know when I spoke with Melissa on the insurance info she said that first my part would be 10,000 but then she said she wAs looking into something and would call me back. She called back saying that going gastric sleeve she could get it where it was just under $3,000 with $2,000 of that being my deductible.

[jilani 16]

I saw dr Nicholson and was told the same. I think insurance approves the surgery for hiatal hernia but does not object to bariatric if it is already paying . Two in one.

In full disclosure I am taking the tougher qualification route to instill discipline.

Btw we're you asked to do a sleep study also?

[iwant2becurvynotlumpy 1]

I saw dr Nicholson and was told the same. I think insurance approves the surgery for hiatal hernia but does not object to bariatric if it is already paying . Two in one.

In full disclosure I am taking the tougher qualification route to instill discipline.

Btw we're you asked to do a sleep study also?

What do you mean by taking the tougher qualification route? I have not yet with him so I am not sure if I'll have a sleep study. My consult is July 23. He is out for vacation and that is his first available date :/

So has your surgery been approved?

[bigfatgoodbye 82]

My insurance does not pay for bariatric surgery. So doc test for hiatal hernia (of any severity) and they said I had a small hiatal hernia. So insurance will get billed for the whole surgery. They will deny the sleeve part but pay the room, anesthesia, etc for the hernia. I did get a sleep study and do have moderate to severe sleep apnea. This did not surprise me. I will get a Cpap machine Saturday for my next sleep study. I stopped breathing 167 times in 5.5 hrs with O2 saturation of only 79%... Killing brain cells every night and waking up exhausted. For most insurance companies this would be enough to pay for WLS with a BMI over 35. For my insurance, it doesn't matter, there is a specific exclusion for WLS. However, getting on the Cpap will usually help you to loose another 10% of excess weight. That is why my doctor wanted me to go ahead and have the sleep study. I was waking up gasping for air at times and choking so I figured I had it. So my total out of pocket should be about $5000.

[ronimom 6]

Bigfatgoodbye- can you tell me which doctor approved yours? My insurance won't cover WLS as well, so I'm hoping to find a doctor who will go the "hiatal hernia" route. So far I haven't found one nearby.

[Ms. Nunya 126]

Interesting....

[bigfatgoodbye 82]

Bigfatgoodbye- can you tell me which doctor approved yours? My insurance won't cover WLS as well, so I'm hoping to find a doctor who will go the "hiatal hernia" route. So far I haven't found one nearby.

Dr Adam Smith of Fort Worth Lap band. He does all types of the surgeries. I went in and booked my date same day. They will tell you when you go in what your insurance will/won't pay. They booked me for EDG and that was that. I put my out of pocket for surgery on my carecredit which he accepts and so does the hospital he uses. I haven't actually paid a dime yet and I'm 1.5 weeks post op. Got 18 months no interest. He has a YouTube video.

[ronimom 6]

Thank you! I have found a couple of others on another forum, so hopefully I can find one that will work for me.

[bransvsgstory 2]

I'm going through True Results and going the hernia route too. I have my EGD and it's the first time I hope it's something so I don't have to pay the $12k, my insurance does not cover wls.

[ttdish 315]

Are all of you local to the clinic doing your HH repair and WLS?

My insurance excludes WLS, but I know I have a hiatal hernia. I live in Minnesota, and I've only just learned about the HH repair option for self pay, but have only seen this offered in Texas.

Do you think it could still save me money doing the self pay/HH repair route if I am out of network?

[ttdish 315]

Well, I did what I should have done prior to posting my question, and called my insurance company. My out-of-network deductible for this procedure is $20k. Dang

[bransvsgstory 2]

Cash pay was only $14k here so that's crazy

[skinnytiff 49]

I used Dr David Kim, hes in Colleyville or Frisco. He does the Making Bariatrics Affordable Hiatal Hernia program too. It all depends on your insurance benefit and if you have an exclusion from bariatrics. When you do the Upper Endoscopy and they see a hiatal hernia, your cash price for the sleeve is $4900 and they bill your insurance for the EGD and hiatal hernia repair.

I've called and scheduled a consult with Dr. Nicholson in Plano, Tx. While I was on the phone the lady scheduling it said you are going the hiatal hernia route. When I asked her what that meant she said the lady with insurance would go over that with me. Anyone know what this means? I know when I spoke with Melissa on the insurance info she said that first my part would be 10,000 but then she said she wAs looking into something and would call me back. She called back saying that going gastric sleeve she could get it where it was just under $3,000 with $2,000 of that being my deductible.