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Does Insurance Cover Hernia Surgery?


The news that you’ll need to undergo hernia surgery is likely to elicit instant worries. You’ll be wondering whether the surgery will work, the amount of pain you’ll endure, how long it will take for you to recover – and more. Then there’s another vital question. Does insurance cover hernia surgery? You’ll 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 Wouldn’t Typically Cover Hernia Surgery
  • Why You Need Help When Pursuing Compensation

Where Insurers Would Typically Cover Hernia Surgery

Your Insurance Plan Covers Hernia Surgery

Each health insurance plan is different. So, it’s best to educate yourself about the financial ramifications of your surgery to check exactly what your insurance plan does and doesn’t cover.

Read the summary you received when you enrolled in your health insurance plan. In this summary, health insurance companies often list what they financially cover and what the excluded costs are for care. If this information isn’t available to you, contact your health insurance company first to avoid financial consequences.

You Have Medicare

If you have Medicare, then it can help cover hernia surgery in most cases. Medicare Part B typically covers 80 percent of the cost after the deductible fee is met. This cost includes a physician fee, facility services and anesthesia as well as prescription drugs for any post-surgery relief.

The deductible fee in 2018 is $183 and after that, Medicare Part B operates on an 80/20 coinsurance. This means Medicare pays 80 percent of the cost while you pay the remaining 20 percent.

For example, your hernia repair cost may come up to $5,000 once all of the costs have been calculated. After you pay the $183 deductible, Medicare Part B pays $4,000 and you’d then be responsible for $1,000 – which would be $1,183 in total.

Although a hospital stay is unlikely with hernia surgery, Medicare’s Part A policy means you would also need to be a deductible fee if a hospital stay is required.

Proof of Pain or Discomfort
Most insurers cover hernia surgery as long as it’s deemed medically necessary. For this, you may need to provide proof of pain or discomfort so that your insurers cover your surgery or Medicare.

Some of the symptoms include:

  • Bulging around a hernia.
  • Swelling.
  • Pain and discomfort when bending down or lifting objects.
  • Nausea.
  • Vomiting.
  • Tenderness or sensitivity at the spot of a hernia.

If you suffer from the symptoms above, your healthcare insurance plan should cover you for hernia surgery.

Where Insurers Wouldn’t Typically Cover Hernia Surgery

You Don’t Hold a Healthcare Insurance Policy

If you currently don’t have an active healthcare insurance plan, then the costs of hernia surgery will come out of your pocket and you won’t be covered.

It’s simple – without a valid healthcare insurance policy, you will have to pay the extensive costs yourself. A study has broken down the estimated costs if you don’t have an insurance policy and need to pay the costs yourself.

  • Estimated facility charges: $3,930
  • Estimated anesthesia charges: $665
  • Estimated hernia procedure charges: $851
  • Estimated recovery room charges: $668
  • Estimated cost for other hospital charges: $1,211

It’s also beneficial to check with your insurers if they cover you when you travel abroad. If not, then you won’t be covered and could be forced to pay out of your own pocket. This can vary from provider to provider so it’s important to check your insurance documents.

You Have No Symptoms

If you aren’t suffering from any of the symptoms highlighted in the previous section, then your surgery might not be deemed medically necessary. If this is the case, then once again, the costs of the surgery will come out of your pocket.

Even if you aren’t feeling any symptoms, it’s possible to undergo hernia surgery. However, a study from Amino has shown that the average cost of hernia surgery across the US is $7,743. In addition to this, several factors can affect the cost of hernia surgery, such as your location, what happens during your procedure, your general health and more.

Why You Need Help When Pursuing Compensation

The majority of hernia procedures see the use of mesh being used ever since it was first designed in 1958. However, recent years have seen an increase in lawsuits arising from mesh complications and failure. These cases are complex and can take years before a settlement figure is even agreed.

If you’re about to have hernia surgery or you’ve recently had one, then it’s important to know the complications you could possibly suffer from. They include:

  • Intense and/or chronic pain.
  • Bleeding.
  • Wound not healing properly.
  • Flu-like symptoms.
  • Tenderness and inflammation.

If you suffer from the symptoms above then you may be eligible for compensation.

The compensation you receive can vary from case to case as it depends on the complications you’ve experienced. The losses you’ve suffered and the overall impact the hernia procedure has had on your life will also come into account.

It’s important to seek legal help to as your lawyer can calculate how much compensation you can claim by reviewing the following:

  • The cost of your surgery.
  • The cost of any follow-up medical attention.
  • The amount of income you have already lost out on.
  • The amount of income you are expected to lose.
  • Punitive damages.

Attempting to do this alone can prove to be very challenging, especially since it can take several years for you to receive compensation. Not only do you have to deal with the symptoms, but there’s also the stress that comes with handling a large court case. This can be even more troubling when you consider that mesh manufacturers hire big law firms who know the rules and regulations thoroughly.

This can damage the compensation you receive if this battle is fought alone.

Instead, your attorney will be responsible for the investigation and ensuring you receive full compensation with plenty of useful knowledge.

To get the compensation process started, it’s recommended to do the following.

  • Consult a doctor. They can determine whether or not your complications are due to your hernia procedure.
  • Find out your eligibility. The criteria is strict so speak to a professional to determine whether or not you’re eligible for compensation.
  • Determine how much damage has been caused. Calculate how much damage has been caused both physically and financially.
  • Find the best attorney to represent you. You can increase your chances of receiving compensation if you choose a qualified attorney. You will need someone who has years of experience with handling hernia mesh lawsuits.

Speak to an Experienced Attorney Today

The easiest way to determine your eligibility on whether or not you can receive compensation, speak to an experienced professional today. At Coxwell & Associates, we have years of experiences in dealing with personal injury, especially hernia mesh lawsuits.

We offer free hernia mesh case consultations, so click on the link below to speak to an attorney today and get a case consultation.

Disclaimer: This blog is intended as general information purposes only, and is not a substitute for legal advice. Anyone with a legal problem should consult a lawyer immediately.