Question:
hernia surgery and tummy tuck charged to ins. just as a hernia repair?

I have a hernia, my surgeon told me i could have both done at the same time and it would be charged only as a hernia repair. If anyone has had or heard of this please let me know. thank you    — Cristy R. (posted on March 3, 2005)

March 3, 2005
Kind of sounds like insurance fraud to me.
   — ChristineB

March 3, 2005
sounds like he is writing off the difference as a favor to you. Many doctors do this and it is not fraud, It is kind. My PS has given me a lot of breaks and is throwing in free stuff on my next PS. Now if you had no hernia and he did a TT and charged as a hernia, that would be fraud and no ethical doc would do that.
   — **willow**

March 3, 2005
Your doctor charged for the hernia and repaired it. NO FRAUD! He gave you the other surgery(tuck) as a bonus. Thank him....it does not happen very often!
   — Oldsoul

March 3, 2005
I agree with the no fraud. If he had billed the insurance for hernia repair, but did not do that surgery, that would be fraud. A lot of cases happen where the insurance will pay for the hernia repair, but refuse the tummy tuck. The patient then has to pay the extra fee for the tuck (although OR and gas man are usually paid already since they would be in there for the hernia anyway). I would not assume that he is not charging you the extra for the tuck or writing it off. You need to discuss the possibility of any extra fees before you go in for surgery.
   — Ali M

March 4, 2005
Clear this mixup with your surgeon. Ask him if he is throwing in the TT to be kind. If that is the case then God bless him/her. You are fortunate to have found a doc that believes in helping people. Good luck.
   — debi327

March 4, 2005
Do not assume the OR and gas man will be at no charge for the time related to the TT. I had the full extended abdominoplasty portion of my LBL covered by insurance and I paid for the lateral thigh portion. The hospital determined which amount of time etc. went with each portion and billed accordingly. My portion was covered by a package price, so I knew what it would be going in. The gas man was covered as part of the package price from the hospital, yet he billed for the other portion to insurance. Same with the surgeon - I pad my price up front and he billed the abdominoplasty portion to insurance. However, he can choose to not charge you for his work. If the whole procedure is being done in his own clinic then he can choose to write off all costs associated with the TT work, but not many PS's have their own clinic. Mine has done substantial rework with my 2nd and 3rd PS's and he chose not to charge me for his work. The revision work I had with the 2nd PS was fairly minimal, probably an hour or so. I did not get charged for that work by the hospital or gas guy because it was such a short time and insurance did not question the total amount of time. If it had been 2-3 hours, like most TT's would take, then insurance may refuse to pay for that much time. My LBL was 10-3/4 hours. You can bet insurance would have questioned an abdominoplasty taking that amount of time, so it was best the hospital separated everything before they billed it. Raised a whole lot less flags. <p>Where I did benefit in cost savings was that insurance was already paying for me to be in the hospital for a few days due to the TT, so the fact that I had the lateral thigh work done wasn't a factor. So once I was out of OR, everything else was covered by insurance as though I would have had it anyway because of the TT. Make sure you find out exactly what costs, if any, you are looking at ahead of time. Don't need a couple thousand $ surpise.
   — zoedogcbr

March 4, 2005
Trust me, your insurance knows that game. I did medical review for 6 years for that type of thing. First, it is more expensive than just a hernia repair, so red flag there to insurance company. 2nd, Dr had to submit CPT codes to get reimbursed for what they do. If he charges way less and no charge for follow up on the TT, cool, but I doubt it.
   — ZZ S.

March 4, 2005
I had this repair done 2.5 years ago. Ins paid for the hernia repair and the TT. The TT was medicially needed because after the hernia repair there was going to be a large amount of skin hanging. This maybe how he plans to give you a 2 for 1 deal. Be sure to ask how he is going to bill and exactly what he is going to do.
   — Peggy R.

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