Insurance coverage – in-network or out. Informal survey.

Hernia Discussion Forums Hernia Discussion Insurance coverage – in-network or out. Informal survey.

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    • #11570
      Good intentions
      Participant

      With the renewal period coming up for insurance I’ve found that I only have one choice of a company that will reimburse out-of-network procedures. All of the others have changed their policies to one that pays nothing at all for out-of-network. In-network reimbursement only.

      Are other people seeing the same? This will restrict the options for people needing hernia repair and/or needing mesh removal after a failed hernia repair. People might have to choose their jobs and the place they live based on their healthcare needs. Find a surgeon, then move to their network so that they can fix you.

    • #17486
      Chaunce1234
      Member

      Unfortunately yes, very limited insurance options for the next year. Everything available is in-network only with a strict EPO or HMO network, with nothing out-of-network covered at all.

      Of course this comes with higher premiums, higher deductibles, higher coinsurance, higher out-of-pocket maximum (and that only applies in-network, it’s apparently billed unlimited out of network), etc. Higher costs and more bureaucracy to no patient benefit. I imagine the same bureaucrats will harass the doctors and demand more paperwork and hoops to jump through for them too, just so everyone is equally miserable with the system.

      quote :

      People might have to choose their jobs and the place they live based on their healthcare needs. Find a surgeon, then move to their network so that they can fix you.

      That is a disturbing thought, but it’s a distinct possibility.

      Trying to find a bright spot somewhere in this mess…. for private practice surgeons it could be a business opportunity, if they put together reasonably priced packages for various surgical options when paid directly without insurance.

    • #17487
      Chaunce1234
      Member
      quote Chaunce1234:

      Trying to find a bright spot somewhere in this mess…. for private practice surgeons it could be a business opportunity, if they put together reasonably priced packages for various surgical options when paid directly without insurance.

      I should add that some clinics already do this. Shouldice in Canada is one, with an all-inclusive price for the entire 4 day stay, and Dr Thomas offers a single quote for a Desarda repair as well. There are probably others.

    • #17490
      Ezzy
      Participant
      quote Chaunce1234:

      I should add that some clinics already do this. Shouldice in Canada is one, with an all-inclusive price for the entire 4 day stay, and Dr Thomas offers a single quote for a Desarda repair as well. There are probably others.

      It’s really helpful to know cash prices for procedures. I have horrible insurance and always ask if there is a cash price. It’s hard to shop around when no one knows what anything costs! My general physician knows I like to pay cash, so he charges me $40-$75 bucks for a visit, which is less then if I use my insurance.

      Besides offering mesh-free hernia repairs, this is one of the things I really liked about Dr. Tomas. The price on the website was exactly what I paid. No surprises. I did find a cash only facility in Maryland that would do a unilateral open hernia repair (with mesh) for $1,800 bucks.

    • #17495
      Good intentions
      Participant

      I found a page on Dr. Grishkan’s site describing the trend of what’s happening in the insurance industry.

      http://www.herniasurgeries.com/cleveland-ohio-hernia-insurance.htm

    • #17614
      dog
      Member

      Just to let everyone know that truly excellent doctor Jonathan Yunis …he takes 2000 without insurance for simple hernia..

      • #27077
        Luke
        Participant

        Not sure where your getting your figures but I was just quoted $3500 for a small indirect Inguinal hernia…which is almost double your $2k suggestion.

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