I agree with PPI-LESS and Denise. Given your financial condition, there really is no "choice" in the matter.
I had one of the last TIF procedures performed in Florida, that was at least partially covered by BC/BS. That was in August of 2011. What the surgeon did, knowing that there were some issues with coverage, was to separate elements of the procedure into various codes, including a "miscellaneous fundoplication" code. I don't remember which one it was, but one of his billings (amounting to approximately half of his fees) was denied and he ended up writing it off. The hospital marked up and then overcharged for the EsophyX device which I disputed, and I ended up having to pay out-of-pocket for a portion of this equipment charge...which was a fraction of what was originally billed to me.
I don't understand how you got as far as you did in scheduling the procedure, when BC/BS requires pre-approval for most surgeries?
If you have a mild to moderate hiatal hernia, there is no conclusive evidence as of yet that it causes GERD. Some folks with HH have no reflux, and others without HH do have reflux. If yours is a paraesophageal hernia, then that is a different matter. Whatever is done in a HH repair, however, does not impact the LES other than it perhaps allows the LES to flex against a narrower hiatus. I understand that it is becoming more and more common to do a HH repair with a TIF, but, originally, the TIF was not available to those with HH larger than 2.5cm. I have a sliding hernia that can reach 2-2.5cm., but it was not repaired. One endoscopy showed this HH (perhaps because the GI overinflated the stomach), and subsequent endoscopies showed none. If you fall into this category, I would suggest another endoscopy, and point out beforehand that you wish to avoid the overinflation problem when measuring your HH. There are many sloppy GIs out there misdiagnosing HH!
What most surgeons do NOT do with respect to recommending the various GERD surgeries, is to separate their patients into symptom categories before making recommendations. The reason this is important is that a procedure such as the TIF is considered a "bridge" procedure (between medication and laparoscopic surgery), and has a relatively low resolution rate for atypical symptoms. If you have mild to moderate heartburn, or perhaps occasional "volume" reflux, it may work as well as a Nissen. Complete airway symptom resolution is unfortunately rare with the TIF.
I don't know where you are located in Florida, but Dr. Rosemurgy in Tampa is perhaps one of the most experienced Nissen surgeons in the country. You may also want to investigate the Hill-Nissen repair, done in Albany, GA by Dr. Bagnato.
You mentioned testing, and that your current surgeon didn't require the tests that someone else does. This concerns me, as fundoplication surgery, however it is done, requires a complete evaluation of the involved organs and tissues. Manometry, barium swallow, biopsies, and pH studies are, at a minimum, requirements.
Post Edited (bcfromfl) : 11/14/2012 1:05:00 PM (GMT-7)