hiatal hernia

okay i had my upper gi and have a very large hernia. in addition the radiologist was astonished that virtually not even water went much past my throat w/o comeing back up.. since my gerd is so awful. causing breathing issues. i thing my life would change if i had it fixed. i was planning to go to mexico for lap band but, the drs wont place it with hernia. the mexican doc charges 600 extra for hernia repair. my inusrance will cover it here at 100% (ive paid all my yr. max.) the issue is i have found a surgeon here who is a baraitric surgeon but also does other types of laproscopic surgery including hernia repair. i have the dreaded bc/bs/regence pebb state of oregon insurance with the exclusion for bariatric and complications. wondering if anyone knows if any docs her would be willing to try for pre approval for hernia repair. and i could pay them out of pocket for lapband? this is the insurance that walter lindstrom has given up on. i read one case history where (and there wasnt even an exclusion) the patient was told she was denied because the doc was primarily a bariatric surgeon (which is rediculous and should be illegal) later she discovered it was because the doc had stated her primary health issue was morbid obesity. im severely obese . dont have a record of trying to get the surgery and being denied. must have the hernia surgery. think its a health risk to have two surgeries (anesthetic, laproscopy etc.) in a short period. anyone have any opinions or knowledge? plastic surgeons have been getting people nose jobs and more by claiming additional health problems. id say a denial would be an obvious blatent predjudice against the obese. susan

Oh Susan - I have the same situation. Same insurance and I had the same problem. I spoke to Dr. Mirande in K Falls about this and his office manager told me they could do both at the same time and I could pay out of pocket for the wls while they had insurance pay for the hernia. But then when I spoke directly to Dr. Mirande, he said insurance would not go for that and that he could not legally do anything to keep them from knowing he did an RNY in the process. He further went on to say that even though it was considered medically necessary the insurance co would look on it as fraud since they would be paying for the hospitalization. I would speak to different bariatric surgeons in your area and see what they have available. I have a feeling you'll hit the same roadblocks I did. But if you decide to go ahead, I would say it might be in your best interest to bite the bullet and put it out in the open with BCBS. Your hernia is more severe than mine, so they might be more inclined to allow this. Mine is fine since I had my RNY. The other option is (I assume you are a state employee?) to go with Kaiser at open enrollment and if you have a bmi over 50 you would be able to get the surgery with them. Dina

hi dina, i will be switching to kaiser in nov anyway (husbands plan) 'my bmi is only 35 with many co-moribitites including intractible spine pain from a failed fusion, very hbp, foot issues, knees, shortness of breath. and now degenerative disc disease in my lower spine. so if they wont consider it unless your over 50bmi well maybe some day ill wind up that high but id have to be pretty round since im only 5'2. i dont think ill live another year at the rate im going. and i dont know if my husbands kaiser even covers bariatric surgery (some dont). but, i had already thrown outn not telling the insurance company. i would have this dr. put in for hiatal hernia surgery. and once approved for the laproscopic procedure he could then tell them he had also recommended lap band at the same time. but, since he knows regence doesnt cover i would self pay that portion. this particular doc does many other procedures besides weight loss surgery. since theyve been doing this for at least 60yrs that i know of for cosmetic procedures (deviated septum for nose job etc) with a whole lot fuzzier diagnosis. i cant understand why they wouldnt pay a significant portion of my hiatal surgery. particularily since it would be medically unsound for me to have to such procedures done in a short period of time and i do qualify for bariatric surgery for all drs and i definatley must have my hernia repaired with or w/o lapband. so whatdya think? sound convincing? i think i just got fired from my mexican dr. before i started . i asked why i should have to pay their all inclusive price pluss another 550 for companion airfare when airfare is currently less than half that. and suggested i wouldnt want the dr. to do my hernia surgery for 600 extra when i can have it done free here. i keep getting fired by dr.s for doing to much research and asking to many questions. but, oh well. such is our wonderful private enterprise system. drs. can fire you for any reason at all or no reason. love it whos bitter. susan

Susan - have you discussed the band with the bariatric surgeon with your serious hiatal hernia? The reason I ask is because Dr. Mirande told me I couldn't have the band even if he repaired the hiatal hernia because it would put too much pressure on the site and possibly cause it to herniate again. I know *nothing* further than that, but his reasoning sounded logical so I didn't pursue it. I would just be asking lots of questions is all. As for the hernia - I don't see how they could deny the coverage if it is as serious as they indicate it is. Either way you have to have it. I hope you are able to get it all done in one fell swoop. Keep us updated! Dina

ive done some research and from what ive read the latest said that it had no effect on the band. but, the reason they did the study was because your drs. theory was well known and accepted. unfortunately for me i dont pay a whole lot of attention to drs. until theyve read the research ive come up with and discussed it with me. which is why dr.s dont like me much. but, its my body and too many of them have totally ruined my life with their arrogance. so i will do the research and require them to consider it and give me an opinion. actuall,y like i said the bariatric surgeon i was considering in mexico wanted just to charge me the extra 600 many docs do it that way they go in and some do9nt charge anything if they find the hernia. i believe and research shows that losing the weight will prevent me from having another hernia. just one of the many ugly side effects of my obesity. thanks for writing as always, susan

I just had the Lap Band surgery with Dr. Patterson in Portland, Oregon and she repaired my Hiatal hernia at the same time... I'd give her a try! She's been wonderful! Good luck!! Jenny