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Will Kaiser Pay for my Hernia Repair?

I had gastric bypass 4 years ago and lost 200 pounds. I have extra skin on my arms I would like removed and I also would like a Breast lift or Breast implants. Last year, I had emergency bowel obstruction surgery and got a large hernia as a result. I want to get all three procedures done at one time: Arm lift, Breast lift, and hernia repair.

Would my insurance (Kaiser) pay for the hernia repair while I cover the cost of the other two procedures?

Doctor Answers (4)

Hernia Repair and Insurance Coverage

+1

Thanks for the question.

Generally speaking, hernia  repair is considered medically necessary procedure and is therefore covered by most insurance plans. Specifics will depend on the individual insurance plan.

Best to check with your primary care physician and his/her referral to the surgery department.

Best wishes.


San Diego Plastic Surgeon
5.0 out of 5 stars 708 reviews

Usually they do

+1

In Sacramento California the Kaiser Cosmetic Center does a wonderful job with weight loss surgeries and plastic surgery reconstructions and they have covered the hernia repairs in the past. Often they will use a cadre of surgeons to accomplish multiple procedures one setting. This is all conjecture and I would suggest asking your cosmetic plastic surgeon at Kaiser this question directly as they will know better. As a non-Kaiser surgeon I do not know what their policy is.

Charles Perry, MD
Sacramento Plastic Surgeon
4.5 out of 5 stars 14 reviews

Kaiser coverage for hernia repair and cosmetic procedures

+1

Kaiser has good Plastic surgeons BUT as a non-Kaiser Plastic surgeon I am ASSUMING that like other company employed physicians they are not compensated for cosmetic surgery.

Everybody loses weight differently and there are different variations in skin excess among different people which therefore require different operation and different prioritization and sequencing of such body contouring procedures. The vast majority of people complain the most about their abdomens since this is where the skin overhang is most visible.

The question that needs to be asked is : Have you had a tummy tuck YET? If not, it would be easiest to coordinate the repair of your ventral hernia (which SHOULD BE covered by Kaiser) with the Tummy Tuck which may or may not be.

The arm lift / brachioplasty and augmentation lift / mastopexy could be stages later to allow you a chance for a quicker recovery.

I would get an appointment with a Kaiser Plastic Surgeon and then ask him / her on what is covered and if so, what the best sequencing of procedures would be.

Hope this was helpful.

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 60 reviews

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Kaiser Coverage for Hernia

+1

Kaiser Permanente, like many health care organizations, covers the cost of medical conditions that affect quality of life. The individual coverage is based on your specific plan, and this may vary from person to person in the same group.  

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 47 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.