Sleeve revision to bypass for GERD and Hiatal Hernia

[jskittles7694 1]

I had the sleeve March 2014 & was good for a couple years, but in 2016 was hospitalized with severe inflammation in my stomach, a large hiatal hernia and GERD. I previously had no history of this prior to surgery. I was prescribed 80mg of omerzapole, carafate and zofran. Been suffering with horrible reflux ever since. In February my pcp added 300mg of zantac. Still no relief and the Bariatric surgeon is now recommending revision to the bypass.
Has anyone experienced this? Did the insurance approve the revision for medical reasons? I have BCBS Massachusetts. Thanks in advance

[AZhiker 2,252]

Before my surgery, I studied the insurance coverage for bariatric procedures, and downloaded all the forms so I could study them so more. I have BCBS TN and revision is absolutely covered, Just be sure to look at everything real carefully so both you and your surgeon know what the requirements are.

[catwoman7 11,214]

a lot of people have had that done. Insurance policies vary, but I seem to recall that many of them do cover it if it's for medical reasons (as opposed to the person wants to lose more weight). GERD would be a medical reason.

[Roserie 302]

I have Kaiser. I had the sleeve in 2013. I've had severe reflux for the last 2yrs. They had also found a hiatal hernia recently. From the discovery of the hernia to surgery date it took me about 6mths to get a revision. I didn't have any issue getting insurance to approve it for medical reasons.

[GG926 41]

Hello.

I will be having the gastric bypass for a large hiatel hernia (also a mass and an ulcer within the hernia sac). I’m very sad and upset because I had bypass 17 years ago and was so sick I had to reverse it. Doc says no choice at all but to do it again or hernia cannot be repaired.

[Losingit2018 1,170]

Sorry to hear that, Grace. Hopefully this time will be different and you won’t stay sick after this surgery. Try to stay positive about it and we will be rooting for you!

PS did you get a second opinion?

Edited May 17, 2020 by Losingit2018

[GG926 41]

Thank you...yes, this is my second opinion. The first surgeon was Dr. Allen Wittgrove (the grandfather of bypass) and my current surgeon is internationally renowned Santiago Horgan. I wish there was another way. I was very sick and dumped constantly. I can’t believe it that with all the technology, there’s no other choice.

[beaker27 37]

Looking for an update from Jskittles. I'm currently having the exact same situation. Had the sleeve in 2017, lots of heartburn issues, developed GERD, through upper GI and EDG, found hiatal hernia. Surgeon is now recommending conversion to bypass. Wondering what insurance requirements were for you, did you end up having the bypass? How are you doing now?