Hernia Surgery Cost

There are several different types of hernia:^1,2

• Inguinal hernia. Occurs in the groin area and is the most common type of hernia. This type of hernia is more common in men, especially during middle age.
• Femoral hernia. Occurs high on the thigh where the leg joins the body. This type of hernia is more common in women.

• Umbilical hernia. Occurs when the gut pushes through the muscle weakness in the navel or belly button. This type of hernia is most common in newborns but can also happen to women who’ve had several pregnancies or are overweight.
• Ventral hernia. Occurs when the bulge occurs through the abdominal wall.
• Incisional hernia. This can occur after abdominal surgery. The surgery leaves the abdomen structurally weaker, which can lead to the intestines pushing through the closed incision and causing a hernia.

The type of hernia you have will influence the type of surgery you’ll need and the overall cost of the treatment.

Treatment for hernias will vary depending on the type of hernia and the severity of the case. The operation can be performed as either a laparoscopic surgery (keyhole surgery) or open surgery.¹

With the exception of some umbilical hernias, hernias will not go away on their own, so if you’re diagnosed with a hernia, you’ll need to seek medical treatment.² Keep in mind that hernias can return in around 10% of cases, so there’s a chance you’ll need subsequent surgery.

 Private hospital insurance can cover hernia surgery, provided you have the right level of cover. Depending on the specifics of your procedure, MBS item numbers for hernia surgeries can fall under ‘Digestive system’ or ‘Hernia and appendix’. The good news is that both clinical categories are minimum requirements for Bronze, Silver and Gold tier policies.

Keep in mind, though, that there may be a ‘gap’ between the MBS fee and what your specialist charges. Depending on your policy, your health fund may cover none, some or all of this gap payment.

However, if you need hernia surgery, there are still benefits to being treated as a private patient in a private hospital, including:

• Avoiding long public hospital waiting times
• Choice of specialist and health care provider
• Private room (depending on availability).

Medicare will cover the cost of hernia repair surgery performed as a public patient in a public hospital. It will also cover some of the MBS fee of hernia operations performed in a private healthcare clinic, while an eligible hospital insurance policy can cover the rest. Without insurance, you’ll have to pay for the rest of the fee yourself along with any additional costs.

While the Australian public health system is essential, it does have downsides compared to being treated as a private patient in a private hospital. Public hospitals often have long wait times for elective surgeries, which could mean waiting months before you’re treated. You’ll also have little say over who performs your surgery and where.

If you’re taking out health insurance for the first time or upgrading your policy, it’s important to be aware of waiting periods. A waiting period is the time you’ll need to wait between taking out your policy and when you can make a claim.

The waiting period for hernia surgery is 2 months unless the hernia is a pre-existing condition, in which case it will be 12 months. This is standard across all health funds.

If you already have health insurance, any waiting periods you’ve served will still be recognised when you switch policies to an equal or lower level or cover, and you won’t have to serve them again.