Sleeve approved in 2 days... hiatal hernia repair still not approved

[piemonade 25]

Anyone else had this?

I have reflux and pain behind my ribcage after eating, thanks to getting a hiatal hernia.

My journey started in December. After my initial appointment with my surgeon, we found out that insurance required a 6 month supervised diet and a psych eval. I met these requirements and my sleeve was approved in a few days. I was excited because I thought I'd have surgery within 2 weeks, basically as soon as he could get me in.

However, we are on week 4. When doing my pre-op exams (an egd, echocardiogram, bloodwork) we found that the cause of my pain after eating is a hiatal hernia. My surgeon wants to fix it at the time of the sleeve to prevent more pain, but my insurance is saying it's an elective procedure they won't cover. He's digging in his heels saying it is medically necessary. I agree. I don't want to hurt forever, and this thing won't get better on its own!

I'm having trouble being patient, and worrying about whether they will cover it eventually.

Anyone else been through this problem? My insurance is UHC.

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[Valentina 2,642]

My surgeon fixed my hiatal hernia when he performed my sleeve surgery --AND THEN billed my insurance for the repair.

It is medically necessary, so I'm not understanding why your ins. company would say otherwise.

In the long run, it's cheaper for them to combine the two surgeries than to have two separate ones.

I just don't understand.

Good luck and post to let us know the outcome.

fingers crossed for you, friend.

[piemonade 25]

FINALLY! I got the call this afternoon and I'm approved. Surgery date 07/25

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[chycky 671]

UHC is known for a bit more bureaucracy than some. Congrats on making it through the barriers to common sense healthcare!