Cost of POEM and Insurance Coverage

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Since my diagnosis and recent acceptance into a clinic that specializes Achalasia in patients who have Lupus SLE like I do,  I’ve been nervously trying to research the cost of POEM and if they are out of my network (or even in mine for that matter) is treatment usually covered? I won’t find out for another week from insurance so I just want to get an idea of what I’m looking at cost wise. My insurance covered all the EGD’s, EUS’s, barium swallow, Esophageal Manometry But I’m pretty worried about the actual surgery. 

Any thoughts? Or experiences anyone could share? You may private email me if that’s allowed on here. Thank you. 

0 likes, 3 replies


3 Replies

  • Posted

    I went through all the tests to find out that my insurance will not pay for it as it is still considered experimental. Frustrating, all those tests were not comfortable just to find out I cannot have the surgery.
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    • Posted

      That’s what I’m worried about. I already know it’s out of my network, and worried about the decision  by the insurance. I guess I’ll just need to wait to hear. It’s not like I’m having elective surgery such as plastic cosmetic surgery.  I need it to fix this worsening problem. I’ve waited this long, guess I’ll wait to hear the verdict. Thank you for replying to my post though, I appreciate you taking the time to respond. Hope you get

      Something going soon for you. 

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    • Posted

      Nothing is happening yet, I guess I will wait until I can’t take it anymore or the procedure will be approved. I’ve gone through all the appeals and it’s a no. 

      Was in the ER  a month ago because my esophagus corked stay for 2 days in the hospital for pain management. Can’t keep doing this.

      Hope your insurance approves the surgery.

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