What You Should Know About Insurance and Sports Hernia Repair Surgery – Part One

sports-hernia-insurance-coverageUnfortunately, most of us have to work for a living. And even more unfortunately, money doesn’t grow on trees. Therefore, it is important to understand what costs are involved with having sports hernia repair surgery, and how insurance comes into play.  The most frequent question we hear is:  is sports hernia surgery covered by insurance?

Let’s start with the deductible. Most people have health insurance that has a “deductible.” If your deductible is $3000, then you are responsible for paying the first $3000 of your medical expenses for the year. Once the deductible is met, your insurance company will cover the rest of your medical expenses for the year. You can use this to help minimize your costs. For example if you have already met your deductible for a given year, then you should try to schedule your sports hernia repair operation before the year’s end. That way, insurance covers all of it. If you have not met your deductible then you should wait to have your operation at the beginning of the following year so that for the remainder of that year, your deductible is met and any additional medical expenses are covered by insurance.

What about coinsurance? Some people have medical insurance that pays a percentage of his or her medical costs. This is sometimes called coinsurance. For example, you may be responsible for 20% of the medical costs and the insurance company pays the remaining 80%.  Most hospitals and surgery centers will not quote you a price for surgery, which makes your budgeting for surgery with this type of insurance difficult.

The Surgery Center submits the bill to your insurance. Now what? For some, dealing with insurance and the bills is harder than the surgery recovery process. Here is what is going on…The Surgery Center will submit a bill to the insurance company. The Surgery Center will try to get as much reimbursement from the insurance companies based on the contractual arrangement as possible. So this bill will be high.

The insurance company will often try to make the Surgery Center look like the bad guy and send you a copy of the original bill. The total amount can be unbelievable. If you have any questions about the billing process, contact Dr. Brown’s office. Before you pay any large bills be sure to contact Dr. Brown’s office. The doctor and staff will help you make wise decisions on which bills are reasonable and should be paid.

What if the Surgery Center is considered out of network? Some surgery centers are out of network. This means that your insurance company does not have a direct contract with the Surgery Center. Thus after the operation is over, the Surgery Center will have to negotiate payment from the insurance company.

What this means is that the surgery center will submit a bill. The insurance company will deny portions of the bill. The Surgery Center and the insurance company negotiate back and forth until a amount reasonable for both parties is settled. Again, you may receive bills from the Surgery Center or from the insurance company. And again, before you pay any large bills contact our office and we will help you make decisions on which bills are reasonable. Your cost with an out-of-network facility is often less than with an in-network facility. Very seldom is your cost more.

Both of the surgery centers where Dr. Brown performs sports hernia repair surgeries are very fair and have excellent reputations for working with our office and insurance. If you have any trouble with the billing or have questions on the process, please do not hesitate contact Dr. Brown or his staff.