HomeCoverDoes Health Insurance Cover Hernia Surgery

Does Health Insurance Cover Hernia Surgery

What Does A Hernia Operation Involve

Surgery Options for Uninsured and High Deductible Patients

The most common place for a hernia to develop is the groin. If the lump can be gently pushed back through the abdominal wall, it’s known as a reducible hernia. If the lump resists any form of pressure, it’s a non-reducible hernia. Both require surgery.

The damaged spot in the muscle wall is repaired by stitching together the edges of the healthy muscle tissue. However, surgical procedures vary depending on the area of muscle wall in need of repair. For instance, special mesh patches are used to repair larger hernias that need to be reinforced.

Will Insurance Cover A Tummy Tuck If I Have A Hernia

Does insurance cover this? Well, the good news is when it comes to an Umbilical Hernia Repair, insurance will usually deem this a medically necessary procedure. If performed in conjunction with a Tummy Tuck, that portion will have to be paid for out of pocket, since it is considered an aesthetic or cosmetic procedure.

Inguinal Hernia Surgery Details

Surgical treatment of inguinal hernia can be performed by open or laparoscopic surgery.

The open surgery is performed under regional anesthesia or general anesthesia. The procedure consists of an incision in the groin area, reduction of the hernia sac in the abdominal cavity, and suturing of the weakened muscle wall, most often with the use of a surgical net for strengthening.

Laparoscopic surgery is a less invasive procedure, with multiple benefits for the patient, that comes with a reduction in the risk of complications, scarring and postoperative recovery. The procedure involves several minimal incisions through which the telescope connected to a video camera and the working instrument are inserted into the abdominal cavity, the objective being the same, to repair the hernia and apply the surgical net.

The duration of the intervention for inguinal hernia is about 45-60 minutes.

Inguinal hernia surgery usually requires two days of hospitalization, followed by a period of 3 weeks before the resumption of activity in the case of laparoscopic surgery, respectively 4-6 weeks in the case of open surgery.

During the postoperative recovery, the patient has no significant restrictions. Heavy physical exertion that contracts the abdominal wall is prohibited. The explanation is simple: this recovery period represents the time required for the wall to be permanently fixed, and the intense physical efforts can lead to its detachment from the fixing points.

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Does Insurance Cover Hernia Surgery

The news that youll need to undergo hernia surgery is likely to elicit instant worries. Youll be wondering whether the surgery will work, the amount of pain youll endure, how long it will take for you to recover and more. Then theres another vital question. Does insurance cover hernia surgery? Youll want to know exactly how much of the hernia surgery your insurance plan would cover and the instances where your bank account could be affected as much as your physical health.

  • Where Insurers Would Typically Cover Hernia Surgery
  • Where Insurers Wouldnt Typically Cover Hernia Surgery
  • Why You Need Help When Pursuing Compensation

How To Pay For Diastasis Recti Surgery If Not Covered By Insurance

Hernia Surgery Cost

If youve decided to have your DR surgically repaired, but are unable to get your diastasis repair surgery covered by insurance, here are some tips for saving:

  • Realize YOURE WORTH IT. A big hurdle in saving was wondering if I was worth it. Most couples have a saver and a spenderIm the saver. Maybe your partner is the saver and consequently balking at the cost. One mental shift happened when I realized I was willing to spend that amount on a carsomething that would definitely not last a lifetime. I realized that having a functional body that Id have for the rest of my life was worth so much more.
  • START EARLY. Preparing and saving for surgery can often take years. The sooner you start saving, the better.
  • CREATE A SEPARATE ACCOUNT, so youre not tempted to spend your surgery savings on other expenses.
  • Set up an AUTO DEPOSIT so you can slowly build up your funds without thinking about it. Dont wait for leftover moneythat rarely happens.
  • Consider taking on another part-time job for EXTRA INCOME to make additional deposits to your surgery fund.
  • ASK ABOUT DISCOUNTS, such as paying with CASH rather than a credit card.
  • LOOK FOR PARTIAL COVERAGE, REIMBURSEMENTS from your insurance, such as getting the hernia portion of the surgery covered, or at least getting reimbursed by your HSA .

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How Much Does Inguinal Hernia Surgery Cost

When it comes to the cost of hernia surgery, there are various factors that can influence your final bill. For instance, open inguinal surgeries tend to be less expensive than incarcerated types because they require fewer incisions and less post-surgery recovery time than other procedures. On average, the open inguinal one costs anywhere between $4,300 and $8,000. Anyway, if you have health insurance, you may have to pay only a part of this amount or nothing at all. It is recommended to ask your insurance company about what is covered. During our research, we found that in case you have health insurance, you will have to pay only $700 to $1,500.

Laparoscopic hernia surgeries are more expensive procedures to go through, costing anywhere between $4,500 and $11,000 without insurance. However, if youre insured, it will cost around $750 to $2,200.

You might also like our articles about the cost of sciatica surgery, toe shortening surgery, or parotidectomy surgery.

Some people may need to delay surgy if theyre not experiencing any pain or discomfort. Doctors typically recommend that these patients be fitted with hernia trusses, which push the bulging organ back inside their bodies and can cost between $25 and $120 on average for one device.

You should know that health insurance companies will generally cover the cost of this surgery as long as your doctor deems it necessary. This could mean the need to providing documentation showing pain or discomfort.

How Much Does Medicare Cover For Surgery

Hernia repair is typically performed on an outpatient basis. As long as its deemed medically necessary, Medicare Part B should help pay for the costs.

  • After you meet your deductible , Part B operates on an 80/20 coinsurance. Medicare pays 80 percent of the cost, you pay the remaining 20 percent.

  • Lets assume your inguinal hernia repair costs $5,000. After you meet your $233 deductible, Medicare Part B would pay $4,000 for your surgery and you would be responsible for $1,000 .

  • In addition to a physician fee and facility services, the total cost of hernia surgery may include the price of anesthesia and drugs for post-surgery pain relief.

If your surgery requires a hospital stay, keep in mind that Medicare Part As coverage and cost-sharing would factor into your out-of-pocket costs.

Medicare Part A carries a deductible of $1,364 per benefit period in 2019, and long hospital stays though unlikely for a hernia repair can be expensive. You would still be responsible for any Part B cost-sharing that is incurred.

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Why Do Hernias Need To Be Repaired

Many doctors recommend surgery because it can prevent a rare but serious problem called strangulation. This occurs when a loop of intestine or a piece of fatty tissue is trapped in a hernia and the blood supply is cut off, which kills the tissue.

Repairing the hernia can also relieve the symptoms of pain and discomfort and make the bulge go away. The hernia won’t heal on its own.

If your hernia does not bother you, most likely you can wait to have surgery. Your hernia may get worse, but it may not. Over time, hernias tend to get bigger as the muscle wall of the belly gets weaker and more tissue bulges through.

In some cases small, painless hernias never need repair.

Preparing For Hernia Repair

HealthTalks – Hernia Repair Surgery With Mesh

Itâs important that youâre as healthy as possible before hernia repair surgery. If you smoke, itâs best to stop before the operation. Itâs also good to lose any excess weight if possible, and to maintain a healthy diet. Try to keep physically active before your operation too.

A hernia repair may be done under local or general anaesthesia depending on the type of hernia. Your surgeon will let you know which, and whether there are any instructions you need to follow beforehand. Youâll often be able to go home on the day of a hernia repair, but this will depend on the type of operation youâre having. For large hernias or more complex procedures, you may need to stay in hospital for a few days. Youâll need to arrange for someone to drive you home.

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Other Items Add To The Cost

The financial toll of surgery extends beyond the cost of an individual procedure. Other costs can include:

  • Pre-operative tests, such as blood work, X-rays, MRIs, etc., that help your healthcare provider prepare for surgery and/or ensure your fitness for it
  • Use of the operating room or setting for the surgery, which has a per-hour or per-procedure cost
  • Co-surgeons or surgical assistants, including healthcare providers and/or nurses, who help in the operating room
  • Blood, plasma, or other biological support you may need to keep your condition stable
  • Anesthesia, intravenous medication, and/or the healthcare provider needed to provide it
  • The surgeon’s fee, which typically is separate from the fee for the actual surgery
  • Durable medical equipment
  • The recovery room or area in which you are cared for following the surgery
  • Your hospital stay if you require inpatient care
  • Skilled nursing facility charges if you require extensive rehabilitative care after leaving the hospital but before returning home
  • Part-time nursing care or therapy you may need during your recovery at home

Depending on your insurance, each of these items may have different coverage levels. It is useful to familiarize yourself with what may be excluded.

Certain services associated with surgery are more likely to be covered than others .

Answer: Umbilical Hernia Is Medically Covered

Umbilical hernia repair is a medicaly indicated procedure and is part of your health insurance coverage. However, you should check the details of your particular plan. For example if you have a high deductable plan or high co-pay plan it could well be less exppensive for you to have your plastic surgeon repair the hernia withoug involving your insurance.

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Is An Umbilical Hernia Repair With A Tummy Tuck Handled By Insurance

As with any medical procedure, the question of cost is usually high on the list of concerns. Does insurance cover this? Well, the good news is when it comes to an Umbilical Hernia Repair, insurance will usually deem this a medically necessary procedure. If performed in conjunction with a Tummy Tuck, that portion will have to be paid for out of pocket, since it is considered an aesthetic or cosmetic procedure.

While a Tummy Tuck aims to remove excess skin and reattach the abdominal muscles to the abdominal wall, a hernia repair often involves the first half of a Tummy Tuck procedure where the muscles are pulled together, which it is commonly performed with a Tummy Tuck.

Sometimes you may need to find a general surgeon as well as a plastic surgeon to perform both procedures at once. It is also very important that you submit exactly what is being done to your insurance company to be sure of what they will and will not cover beforehand.

Sometimes your surgeon may not advise you to receive both procedures at the same time. There is a greater risk for impaired blood supply to the umbilical stalk or the hernia may not be in the best place to also perform an abdominoplasty.

Call our office today and schedule a consultation to speak directly with Dr. Hovsepian today.

How Can I Save Money

Sports Hernia Surgery

There are a few essential things that you should do before trying to find the best prices for your surgery. It would help if you did your own research and call around hospitals, but also look at outpatient centers because they could save even more money in the total cost of care.

If you cant afford to pay the whole cost yourself, try and find a health insurance plan that covers at least half.

In most cases, hospitals offer discounts for paying upfront or meeting income requirements. Ask the hospitals finance department if you can take advantage of these savings.

It is often easier to find affordable hernia surgeries when looking overseas.

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Important Points To Considerwhen Choosing Your Hernia Surgeon:

  • Be sure to find a surgeon who focus on hernias, makes them a priority in their practice, tracks their patient outcomes and publishes that data for future patients to review. This will help you choose a quality surgeon for your care.
  • Ensure your surgeon performs a high volume of hernia surgeries. No one in any field can be proficient if they are only doing something a couple of times a month.
  • Being treated at a specialized hernia center with an in-house accredited Ambulatory Surgery Center provides the highest quality care before, during, and after your hernia surgery and allows for more successful outcomes.
  • Patients should be seen by a surgeon who can offer all forms of hernia surgery, including open lightweight mesh techniques, as well as advanced laparoscopic techniques. This ensures your surgeon can offer the best technique tailored for your case.
  • Most laparoscopic patients experience less pain postoperatively and often can return to normal activities sooner. Laparoscopic hernia surgery can result in better patient experiences for some patients.
  • The newest, advanced lightweight mesh reduces not only the recurrence rate for your hernia, but also the chance of postoperative mesh pain.

75% of hernias will get progressively larger and more painful with time! We highly recommend scheduling a visit with us when any hernia symptoms occur.

What Expenses Are Covered By Health Insurance

Even though hernia surgery is covered by insurance, each and every policy is different. It exclusively depends on the policy you purchase. The good thing is most health insurance policy gives you the freedom to customize the plan and coverage by paying additional premiums. This ensures that you get ample coverage for all the critical illnesses you are prone to.

Typically, the following expenses will be covered by most health insurance policies-

If you want to know the specific costs that will be covered by the health insurance for hernia surgery, here is a list-

  • Hospital admission and discharge

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How To Get Medicaid To Cover Tummy Tucks

If youre wondering how to get a tummy tuck covered by insurance, there are a few rare cases in which Medicaid will pay out. In the vast majority of these cases, there are either extenuating circumstances or the doctors will perform a procedure thats similar but not identical to a tummy tuck.

If youre wondering how to get insurance to cover a tummy tuck, youll need to prove that you need a medically necessary tummy tuck. Unfortunately, explaining to your insurer that boosted self-esteem will improve your overall health typically wont fly as an excuse when youre wondering, Are tummy tucks covered by insurance?

One situation in which Medicaid will pay out for your tummy tuck is if the excess skin is causing you back pain because of the additional weight its putting on your spine. You may also have incontinence that can be solved by a tummy tuck, but those are essentially the only cases in which a tummy tuck will be performed on its own and covered by your Medicaid.

Can a tummy tuck be covered by insurance in other circumstances? There are times when a doctor may perform a tummy tuck at the same time as another procedure. For example, if you go in for a hernia repair and the doctor performs a tummy tuck at the same time, it may be covered by your Medicaid.

What Is A Hernia

Ventral Hernia | General Surgery Video Lecture | Doctors V-Learning | sqadia.com

A hernia happens when an organ pushes through the muscle wall that surrounds it. This is normally caused by muscle strain or weakness. Hernias can result from factors including:

  • injury

Most hernias happen in your abdomen, but they can happen anywhere. You might notice a bulge under your skin where the hernia occurred.

The symptoms of a hernia can vary depending on the type of hernia you have. Some hernias have no symptoms. Others may cause symptoms like pain, swelling, difficulty swallowing, or nausea.

Hernias dont go away on their own and can have serious and even life threatening complications.

Surgery is generally the only treatment for hernias. However, you might not need surgery if your hernia is mild and not causing you pain. Your doctor will instead monitor your hernia and prescribe medications that can help prevent further symptoms.

Youll need surgery if your hernia continues to grow or is causing you any symptoms.

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Answer: Will Insurance Pay For Hernia Surgery With Tummy Tuck

Hello! Thank you for your question! Surgical procedures for aesthetic purposes, to improve appearance, are not covered by insurance. Typically, these as well as complications resulting from such procedures are the responsibility of the patient. Procedures that are meant to correct functional issues and those which cause health-related issues should be covered by your insurance as a medical necessity, with proper examination and documentation. Some insurance plans have exclusion criteria for certain procedures. Also, it is an obligation of the surgeon not to attempt to authorize purely cosmetic procedures through insurance. This is an excellent opportunity and time to combine these procedures. Facility and anesthesia times should begin upon completion of your hernia repair. Discuss your issues and complaints with a board-certified plastic surgeon to discuss these as well as to examine and assist you in deciding which procedure will be the best for you. A discussion of the advantages and disadvantages will take place along with the risks and benefits. Insurance companies will vary on coverage and is always reasonable to discuss your issues with your surgeon and primary care. It would behoove you to get as much information as possible and even call your insurance yourself. Certainly, pay in advance prior to your surgical procedure and options such as financing are available if you qualify. Hope that this helps! Best wishes!

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