Question:
Bypass to correct Hiatal Hernia

I recently read an article about gastric bypass being a suitable and acceptable procedure in place of the Nissen Fundroplication (sp) for the treatment of GERD and Hiatal hernia. I was also reading on the AMOS site as I am getting ready to start the appeals process with BC/BS. I came across a comment that BC/BS said if this surgery was for another problem OTHER than weightloss that would be a different story. Well I do remember speaking with a REP from BC/BS on the ICD Code for bypass, which she said was an "acceptable" procedure. NOW.....here is my thought. I am having my gallbladder removed, as well as the bypass correcting my hiatal hernia. WHY, if any, do I need to request this surgery based on the fact of me being morbidly obese? Why can I not request approval for this procedure to repair my hiatal hernia as well as treat GERD? Leave out the diagnosis of morbid obesity all together. Next year when I request approval for my hysterectomy, it certainly won't be because I am obese, it will be because my uterus and ovaries are going haywire, which is do in large part from being obese! Seems logical to me.....anyone else?    — lesleeloo (posted on July 22, 2002)

July 22, 2002
Leslie, it does seem reasonable to me too! I had a HH and my symptoms since surgery have vanished!Have you asked your surgeon to try resubmitting for approval using your HH as the reason instead of MO? Good luck!
   — NicoleG

July 23, 2002
Hi Leslie, I too have a H.H. that was discovered before surgery. My surgery wasd approved for Weight loss, but they would have approved it for the H. H. or so I was told. I don't see why you couldn't go that way. I have no symtoms from the H.H. anymore and am happy as a bug in a rug. (4mo post op) Good luck.
   — MnShadows