You are in CA - which DS surgeons are in-network for you? Because if there is no
qualified in-network surgeon (keeping in mind your reasonable desire to have ALL of these problems fixed at once), then your insurance almost certainly has to pay for you to go to a qualified out-of-network surgeon.
If your plan is an HMO, even better, because there will NOT be a qualified surgeon in-network, and Larra and I have helped people with this situation before.
What you have to do is to request your PCP to refer you to Keshishian as a covered out-of-network referral, because there is nobody in-network who can deal with your medical situation in one surgery, and you want ONE surgery. S/he will say no, or she will make the request to the HMO managed care for the out-of-network referral, and you will in either case get a denial, vesting your appeal rights.
Then, while we help you appeal the denial, you will
self-pay for a consult with Dr.K, who we hope can write you an LOMN that says you need the switch, and that he can also repair your umbilical, abdominal and hiatal hernias at the same time. It is more likely than not that the DMHC will overturn the plan's denial. And you should get reimbursed for the cost of the consult
That's how to handle it from an insurance perspective.
However, depending on how much of a problem the abdominal and umbilical hernias are, I would like to point out another set of considerations.
- You are still MO, I assume.
- If you get the abdominal and umbilical hernias fixed NOW, you are not going to have as good a cosmetic result as you would if you could wait until after you lose more weight after getting the switch.
- In fact, if you can wait, it is possible that you could get them fixed AND get a proper abdominoplasty covered by insurance (again with help from me and Larra - I got my husband an abdominoplasty to avoid the use of mesh to repair his umbilical hernia, and he got a bit of a FUPA lift as a bonus).
- Similarly, it is possible that your surgeon is right and that you might not need a hiatal hernia repair after you lose more weight - and a hiatal hernia repair after having a sleeve is more difficult, because there is no fundus to make the Nissen fundoplication wrap (@Larra, do I have that right?). But that is something to ask Dr.K.