I read on here that someone had hernia surgery with a plastic surgeon and insurance paid for it. I am looking to have the same thing done and would like to know what all was covered.
From the insurer's point of view a plastic surgeon is just a surgeon. Coverage is based on the procedure performed (and the diagnosis), not the training of the doctor.
Just to add to Scott's note: while the insurance company does not care who performs a hernia repair, they are unlikely to pay the additional fee for a specialty surgeon. They will pay the reasonable/customary fee for a general surgeon, unless there is a specific need. Plastics coverage is generally reserved for facial repairs and hand/foot injuries, as they are considered medically necessary. Abdominal repairs with plastic surgery are considered cosmetic and are not covered.
Hi: When I had incisional hernia repair in 2012, my surgeon who has done by J-pouch and reversal did a plastics repair when closing...very much improving the huge scar that had been there. I was not that upset with it in the first place, but he seemed quite happy with the results. So he was a GI surgeon, not a 'plastic surgeon'.
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