RNY Revision & Hiatal Hernia

Can someone tell me if the revision is/should be covered when repair is done to the Hiatal Hernia?  I spoke with a DR and really got excited because I thought the one could be repaired with the other, however I was informed that BCBS would not cover the RNY revision, but I could pay $15,000 for the revision using Care Credit  (the charge for a new RNY surgery), and the hospital charges would be paid for with the repair of the hernia. Has anyone had this repair and revision done with BCBS as their provider.  I have reflux that has backed up into my esophagus!

Hi!  I just had the same issue.  And I am on my 5th day out of my revision surgery.  YEA!  Do stress, and I mean stress that you are having reflux... I would go on that as my main concern instead of the hernia.  It worked for me... but I have a great, compassionate and caring dr.

Hi, Thanks for responding. If you don't mind my asking what type of revision did you have?  I thought I had a really good dr, but attempting to pay $15,000 is a bit much for me.  I would like to get the RNY revision.  My stomach looks like an hour glass in the x-ray (they actually gave me copies of them) and the reflux is horrible.  But I feel like there are no other options. 

Not a problem... happy to help.  I had a gastric bypass revision.  I had started to have awful reflux, sleep apnea, and joint pains so the dr. wrote a letter to the insurance and it was approved in 2 days.  When you see your dr. really tell him that the Reflux is unbearable to live with.  If that dr. can not help... find one that can.

One cheaper option might be to cut a deal with your doc.  Get the HH repair under insurance and while they are operating do the revision.  Just pay for the MD cost of revision and let insurance pay for everything else.

Not all insurance co's go for that because of added OR time, added anesthesia costs, hospital costs, etc. but it might be a way to cut down on some expenses.

Hi, Thank you for your suggestion, however $15,000 is ALOT of money for the MD cost!  That is what is asking for.  I guess I will just wait and see what happens.  If the insurance covers the cost of the operating room, anestesia, and hospital stay.  This is alot for just the MD. 

I know that has got to be a better way, my x-rays show the ruflux (G.E.R.D) more than midway of my esophagus. 

But wouldn't much of that $15K but cut down since ins will be paying him a bulk of it?

Hi, that is what I thought at first too, but this is what he is asking up front.  He stated that I could get the $8,000 or whatever the amount I would be charged for the surgery back, but  since he is out of network he is not sure what that amount would be, and he would charge me the cost of a new RNY surgery.  I had an RNY done in 2000, he stated that the procedure was a failed job, but that he didn't think my insurance (BCBS of Illinois) would cover the cost of the revision even though part of my stomach is in my chest, however he was NOT even willing to attempt to check with the insurance.  It was $15,000 or nothing.