What if my hernia is a pre-existing condition?

If your hernia is deemed a pre-existing condition you will typically need to serve a 12-month waiting period before your private health insurance will cover the surgery. A pre-existing condition is generally any illness or ailment you had signs or symptoms of in the 6 months before you took out or upgraded your hospital cover.

What are the typical waiting periods for hernia surgery with private health insurance?

For new conditions you generally have a 2-month waiting period before you can claim for hernia surgery. If your hernia is considered a pre-existing condition this waiting period extends to 12 months.

Does private health insurance cover all types of hernia surgery?

Most private hospital policies from Bronze tier upwards will cover common hernia repairs including inguinal hernias, femoral hernias, umbilical hernias and incisional hernias. If you have a less common type of hernia or require complex surgery it is always best to check with your insurer.

Does the surgical method for hernia repair affect my health insurance cover?

Both open surgery and laparoscopic keyhole surgery for hernia repair are generally covered by private health insurance as long as the treatment is listed on your hospital policy. Your surgeon will decide the most appropriate method for your condition.

What happens if I need emergency hernia surgery?

If you need emergency hernia surgery you will likely be treated in a public hospital through Medicare without any out of pocket costs. However if you have private health insurance and have served your waiting periods you may still opt for treatment in a private hospital if a bed is available. For some life-threatening emergencies waiting periods may be waived but this is at the discretion of your health fund and should be confirmed directly with them.

Does my health insurance cover consultations and diagnostic tests before hernia surgery?

Private health insurance hospital cover is designed for inpatient treatment in a hospital. This means it generally does not cover outpatient costs like initial specialist consultations or diagnostic tests such as ultrasounds or CT scans when you are not admitted to hospital. Medicare will usually cover a portion of these costs.

Can a hernia recur after surgery and will health insurance cover a second operation?

While hernia surgery is generally effective there is a small chance a hernia can recur. If this happens and you have maintained your hospital cover your private health insurance will typically cover the subsequent surgery subject to your policy terms and any applicable waiting periods for new or pre-existing conditions.

Are there specific health insurance considerations for children needing hernia surgery?

Yes children's hernia surgery is generally covered under family health insurance policies or policies that include dependants. As with adults a Bronze tier or higher hospital policy will typically cover the procedure. Waiting periods will still apply for new and pre-existing conditions.