Does Health Insurance Cover Hernia Surgery

Most insurance providers, including Medicare, are likely to cover hernia surgery if it is deemed medically necessary.

To qualify for coverage, you may need to provide documentation demonstrating pain or discomfort.

Does health insurance cover hernia surgery
Hernia surgery is usually covered by health insurance or mediclaim policies, but coverage details depend on the policy and surgery nature: Photo source (eHealth)

What is Hernia?

A hernia occurs when an organ or tissue protrudes through a weakness in the surrounding muscle or tissue.

It can emerge in various parts of the body, such as the abdomen, groin, and chest.

If you experience symptoms like a bulge or pain in the affected area, consult a healthcare provider for diagnosis and treatment to prevent complications.

Untreated hernias can lead to issues like organ blockage or strangulation.

Seeking prompt medical attention is crucial.

Is Hernia covered under Health Insurance?

Many policyholders wonder if health insurance covers hernias.

Generally, most health insurance plans cover the costs of hernia surgery and related medical treatments, but coverage specifics vary depending on the chosen plan.

Some plans may have sub-limits for hernia surgery, while others cover costs up to the sum insured. Waiting periods or exclusions may also apply.

Carefully review your health insurance plan to understand the coverage details.

Seeking guidance from a healthcare professional or insurance agent can help you choose a plan that suits your needs.

It’s crucial to select a plan offering the necessary coverage for hernias to avoid untreated conditions.

Consult your healthcare provider and secure yourself from unexpected medical expenses with health insurance.

Does Insurance Cover Hernia Repair Surgery?

Considerations for a medical procedure often revolve around costs and insurance coverage.

Fortunately, insurance typically considers Umbilical Hernia Repair a medically necessary surgery.

However, if combined with a Tummy Tuck, the cosmetic aspect may require out-of-pocket payment.

While a Tummy Tuck addresses excess skin and abdominal muscle reattachment, hernia repair often involves the initial steps of the Tummy Tuck.

Coordinating both procedures may necessitate consulting with a general and plastic surgeon.

Communication with your insurance provider is crucial to determine coverage.

Surgeon advice varies on simultaneous surgeries due to potential complications like blood supply issues and optimal hernia location for abdominoplasty.

Understanding medical expenses and insurance coverage is essential. Dr. Hovsepian aims to guide you through the process, discussing risks and ensuring your confidence in choosing plastic surgery.

For personalized assistance, schedule a consultation with Dr. Hovsepian by calling our office.

How Much Does It Cost To Get A Hernia Removed?

Hernia repair surgery in the U.S. averages $7,750, but costs vary based on insurance and surgery type.

Inpatient procedures are generally more expensive than outpatient ones.

Factors affecting costs include insurance status, facility location, and geographical region.

Consult your doctor to discuss the best option for your needs. Always communicate symptoms and treatment preferences with your healthcare provider.

Also read: Does Chambers Of Commerce Offer Health Insurance

Is Hernia Surgery Medically Necessary?

Doctors often recommend surgery to prevent a rare but serious condition called strangulation, where a hernia can cut off blood supply to trapped intestine or fatty tissue, causing tissue death.

Hernia repair not only alleviates pain but also removes the protrusion, as hernias don’t heal on their own.

If the hernia isn’t causing discomfort, you may choose to avoid surgery, but there’s a risk of it worsening over time as the abdominal muscle weakens and more tissue bulges through.

How Long Is Recovery From Hernia Surgery?

Most people undergoing open hernia repair surgery can go home the same day, with a recovery period of about three weeks.

After this time, you can gradually resume light activities, avoid strenuous exercise for at least 6 weeks, and resume driving when groin pain subsides (usually around 2 weeks).

Sexual activity can typically be resumed after three weeks.


Post-hernia surgery, swelling near the incision is normal and doesn’t indicate a failed procedure.

To reduce swelling and pain, apply ice or a cold pack for 10-20 minutes every 1-2 hours, placing a small towel between the ice and your skin.

If you have any of the following symptoms, contact your doctor:

How Serious Is A Belly Button Hernia?

An umbilical hernia is not harmful in and of itself, but it can become stuck (incarcerated).

This can cut off the blood supply to the hernia’s contents, resulting in life-threatening illnesses including gangrene or peritonitis (if this happens, the hernia is said to be strangulated).

Does Insurance Cover Abdominal Muscle Repair?

Unless deemed medically essential, insurance usually does not cover the surgery for men or women.

When combining DR surgical repair with umbilical or hernia surgery, insurance most commonly covers it.

Can A Tummy Tuck Fix A Hernia?

In short, you can combine hernia repair with a tummy tuck to address umbilical or ventral hernias by tightening the upper and lower abdomen.

The surgeon makes an incision around the belly button and extends it to the hips, lifting the skin and tissue.

Hernia repair involves pushing the protruding organ back, removing excess tissue, and tightening abdominal muscles.

This can strengthen muscles, reducing strain and skin irritation.

Will Insurance Cover Abdominal Wall Reconstruction?

In short, insurance usually covers ventral hernia repair, but procedures like vertical abdominoplasty or liposuction performed alongside may lack coverage.

Insurance covers the ventral hernia repair, but not the abdominal wall component in such cases.

How Long Does A Hernia Surgery Take?

Open surgery or laparoscopic (keyhole) surgery can be used to correct an inguinal hernia.

Before the operation, the hospital will email you instructions on when you should cease eating and drinking.

The procedure typically takes 30 to 45 minutes to perform, and you will be able to return home the same day.

If they have other medical issues or live alone, some people spend the night at the hospital.

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