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Nissan laproscopic fundoplication

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Posted 2/27/2010 2:49 AM (GMT 0)
Hi,

I am scheduled to have this surgery next week as an inpatient procedure. I just found out today that my insurance company will only approve it as an out patient procedure. My surgeon says he will not do it as out patient and that it is medically necessary for me to stay inpatient. They also said the hospital would not release me because they feel it is medically necessary for me to stay.

I would like to know your thoughts on this. Did any of you have this done as outpatient? Any suggestions on what to do? confused
Posted 2/27/2010 2:58 AM (GMT 0)
Terri,

I had this surgery done as an inpatient. I was able to leave very early the next morning, but it does seem like there is some benefit to the overnight monitoring. I would be more comfortable doing it the way your doctor believes is necessary. It seems like your insurance co is not viewing this as a major surgery, I hope that you can get them to come around.
What day is your surgery?
We are around if you have further questions.
All the best!

Stacey

Wrapped 1/18/10
Posted 2/27/2010 3:06 AM (GMT 0)
Mine was done out-patient with 24 hour observation. Is yours laproscopic or open? open usually requires longer stays. Do you have health complications that make it a need for you to stay longer?
((((((((((((((((((hugs))))))))))))))))))))))
Relax, it wasn't so bad. I had pain for about three hours after the surgery and only took strong pain meds four times after I got home. Just relax and recooperated afterwards. Don't overeat. Stay on liquids for at least two and half weeks, don't lift anything over five pounds for six weeks. Limit bending over for at least two weeks. And come back to let us know how you're doing.


Joy
Posted 2/27/2010 3:14 AM (GMT 0)
My surgery is on Monday, March 8th and will be done via laproscopic. My insurance company won't budge per my doctors office. My surgeon won't do it as outpatient. He is one of their participating providers. They said the insurance company covered it as a 1 day stay last year and this year was the first time they want it done as outpatient.

I don't know if I should have the surgery. All my doctors say I need it done due to Barrettes and ulcers. I also have a hernia so I guess that needs to be fixed. I have gastroparesis and pancreatitis as well. I am not sure what to do.

I left it with the doctors office today (its actually at USC Hospital), that I would go ahead with the surgery. I just don't want to get stuck with a huge medical bill. To make matters worse I work for the insurance company and have worked for them for over 25 years.
Posted 2/27/2010 3:21 AM (GMT 0)
Do you think the doctor can get special approval for you?
From your description you really need this surgery.

Mine cost about $4,000, but with insurance and all I only had to pay about $800.
I hope something can get worked out.
Maybe you can get the insurance to cover the surgery, but you pay the room stay fees?

Joy
Posted 2/27/2010 3:31 AM (GMT 0)
They tried. Bottom line I would have to fight it after.
Posted 2/28/2010 12:57 AM (GMT 0)
Rats! I wish you luck. I pray everything goes good for you.

Joy
Posted 2/28/2010 2:01 AM (GMT 0)
Outpatient is anything under 24 hour stay and doesn;t start until you are in your room after surgery. Maybe that would be long enough if you promised your surgeon to return immediately if anything isn't right. You then would be a readmit and should be covered for complications. Just a thought. I stayed 3 days the first time and three days the second time and was readmitted the next day for 3 weeks. Things do happen.

Take care,
Bill
Posted 3/1/2010 12:05 AM (GMT 0)
There has to be an appeals process. Iwould have the surgery, since your case is bad, and fight it later. Worst case: ask the hospital to allow you to pay anything the insurance doesn't cover at the rate the insurance would pay, which should be less than half.

It is totally ridiculous for an insurance to not cover the medically necessary stay! This is not an outpatient procedure!
Posted 3/1/2010 1:53 AM (GMT 0)
I am so upset over this. I am going to call the surgeon on Monday. His nurse said he would not agree to my only staying there for 23 hours, I want to hear from him. I figured I will cancel the surgery if he says no, but I guess I could check with the hospital to see if they would work out something with me for over the outpatient amount, but that would mean they would have to bill it as outpatient, wouldn't it?

I do have a copy of the appeals from, but it will take a bit for it to go through the process.

I am also going to call other "participating" surgeons under my plan to see if they are doing this procedure as outpatient. That will help me to either pick a new surgeon or to use in my appeal.

This really sucks that the insurance company is also my employer.
Posted 3/2/2010 2:09 AM (GMT 0)
From what I can see I have lost this battle. The doctor won't change from inpatient to outpatient the hospital won't work out anything on the bill, the insurance company won't budge and my GI doctor does not know any surgeons that will do this outpatient. I have truly given up.
Posted 3/2/2010 11:36 AM (GMT 0)
Okay folks! Let's team up and find Terri a doctor who does this outpatient. Terri, we need to know what state you live in.
If you're in GA or surrounding states, I've got an excellent doctor...Dr. V.John Bagnato, in Albany, GA. He takes out of state patients.

Don't give up!

Joy
Posted 3/2/2010 11:52 PM (GMT 0)
Wow that sucks! What I can't believe is that you work for the same company. The irony. Joy is right don't give up- look for other options. Vote with your feet. MM
Posted 3/3/2010 2:28 AM (GMT 0)
Terri,
Wow. So sorry you're struggling with this. I do think, though, I did hear from someone on this forum (from a different country) where the lap nissen is done as an outpatient procedure. When I had mine, I went in one morning, and came out the next morning. In most cases the procedure doesn't require a long stay. Of course, you never know. There can be unexpected complications.

I think Bill has a good idea...could you ask your doctor about that possibility?

Terri, I think it's more important that you have a surgeon who is eminently qualified and experienced in the Nissen Fundoplication procedure. You can't just go with any surgeon who's willing to do it. Your successful outcome is dependent upon a surgeon who has had lots of experience doing this particular procedure.

This is very stressful for you. I'm not sure it's something you want to go forward with if you have so many financial concerns. Could you do the appeal and reschedule after you've won? I think you'll win...it's hard to believe that an insurance company would not be able to be persuaded. I may be too optimistic. Something has to be done about this crazy insurance situation. It's not at all fair.

Lots of people here have had the surgery, and we can support you through it. We'll try to answer your questions, and help you through.
It's a surgery that I'm very glad I had, and wish I'd done it sooner.
Best wishes with your decision. Let us know what you decide!
Take care,
Denise
Posted 3/3/2010 3:00 AM (GMT 0)
Hi all,

I talked to the surgeons office today. They will do the surgery as outpatient, however, if they feel it is medically necessary for me to stay longer,they will bump me up to inpatient. What would help me, is names of surgeons in California (Los Angeles or Ventura County) that do this procedure and if you know if they do it inpatient or outpatient. If you don't I can call myself and ask. I just want to know in case they do end up admitting me so that if I need to fight the claim I will have some additional info that will help me. THE SURGERY IS BACK ON!
Posted 3/3/2010 6:14 AM (GMT 0)
Terri-
That is great news! Way to keep fighting!

Take care,
Bill
Posted 3/3/2010 12:42 PM (GMT 0)
Glad to hear it, Terri. Best wishes!
We're here to offer our support and share our own experiences with the surgery.
Take care,
Denise
Posted 3/3/2010 10:40 PM (GMT 0)
Yea, You go girl! I knew there was a way.

Look up the America Gastroentrologist Association. They have a list of surgeons in your area and ratings.

Joy
Posted 3/6/2010 5:00 AM (GMT 0)
Ok. I found the America Gastroentrologist Association site, but I can't figure out where on the site they have the list of surgeons.
Posted 3/6/2010 4:13 PM (GMT 0)
Oops! I think I sent you to the wrong site. I'll look around and see if I can find it again. Hmmm...

Joy
Posted 3/11/2010 8:56 PM (GMT 0)
Hi all,

I had my surgery and am out of the hospital. I ended up leaving after two days as I was having problems with nausea. I feel much better today.
Posted 3/12/2010 3:00 AM (GMT 0)
Yea! Keep that anti-nausea med handy. Stay on liquids for at least three weeks. Never put more than a half cup of food at a time in your stomach. When you get hungry eat. Keep the meals small and frequently.

Joy
Posted 3/12/2010 3:01 AM (GMT 0)
Thanks - drank a little too much at a time for a meal today and understand why I need to keep it small. I will and thanks for all the good advice!
Posted 3/12/2010 4:16 AM (GMT 0)
Good to hear Terri! Keep us posted on your recovery! Heal well! MM
Posted 3/12/2010 9:55 PM (GMT 0)
I limited my lifting and bending over to no more than 5 lbs at a time. Hold a pillow over your stomach to ease the pain when you cough, get up, sit down, or walk, it helps alot.

Joy
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