Don’t Let Insurance (or Lack Thereof) Keep You From Sports Hernia Surgery

You’ve been through the doctor appointments, the specialist visits and the consultations. Now, sports hernia repair surgery might be in your future. Even with recovery as your top priority, it’s hard to ignore the calculator in the back of your mind adding up the costs. Unexpected medical bills can throw even the most careful budgeter off track. It’s important to understand how insurance can affect the costs of sports hernia repair. Different plans and costs can be confusing, but Dr. William Brown’s team has years of experience working with patients to find the best financial options, whether you have health insurance or self-pay.

Most insurance plans have a deductible. This means that you’ll pay your deductible amount before insurance covers any costs. If your deductible is $2000, then you’re responsible for the first $2000 of your medical expenses. After you pay your deductible, insurance covers the rest of your bill. This amount renews each year. If you have already paid most of your deductible for the year, then it’s often better to have surgery before the new year, when your deductible starts over.

Other plans are based on coinsurance. In this system, medical insurance pays for a percentage of medical expenses and you cover the rest. For example, you may pay 25% of total costs, while your insurance will pay the other 75%. This can be tricky when dealing with major operations (like surgery). Often, hospitals won’t state upfront what the cost will be, so it can be difficult to budget for a procedure. The two surgical centers that Dr. Brown works with are very reasonable with their billing and work with our office to ensure fair pricing.

What happens when you’re charged for a visit? The provider (Dr. Brown’s office, the physical therapy clinic or the surgical center) sends your insurance the bill. At this point, the provider is trying to get as much reimbursement as possible from your insurance, so your bill will seem sky-high. Before you pay any costs that seem unreasonable, be sure to contact Dr. Brown’s office. His team has been through this process many times, and can help you make the right decisions about when costs are appropriate and when they are not.

Surgical centers and other providers can be considered out-of-network. This means that your insurance and the provider don’t have a contract together. When the insurance receives your bill, they’ll have to negotiate to determine the final price. This might make the process longer, but it doesn’t mean that you’ll end up paying more. You might even receive enormous bills before the negotiations are done, but if anything seems off, contact Dr. Brown’s office.

Doing the mental math on how to pay for sports hernia treatment can be tough. What doesn’t have to be tough is figuring out the bill. Navigating insurance can be tricky, but Dr. Brown’s team is here to help. Experienced and knowledgeable, his office staff will work with you to ensure that your path to recovery isn’t made harder by billing and payment challenges.