[Noah930]

Not covering a pre-existing condition: to a certain extent, you have HIPAA to thank for that kind of problem. Just remember: insurance companies exist to make money. They'd just as soon sell shoelaces if they thought they could make more money doing that than trying to take care of people.

Surgeon's fee: that's about double what I get paid by insurance here in CA to do a routine hernia (don't know if what your wife has is inguinal, umbilical, incisional, or ventral, but I haven't found the payments to be too different between them). The surgery should take about an hour or so. All your post-operative care (by the surgeon) is free, so to a certain extent, factor that into the price you're paying up front.

Anesthesia fee: It's a great gig, ain't it? They make more money than the surgeon. Yet there's really no pre-op work-up they have to worry about, and no post-operative coverage either. No office overhead. They're there for the procedure, and that's it. Complication or pain issue at 2 in the morning? Not their problem. If I knew then what I know now, anesthesia would have been a lot higher on my list of career pathways.

Hospital fee: Sounds like you're having this done at a hospital, rather than a surgicenter. Hospital is going to be a lot more expensive. An OR, there, is staffed and equipped for all sorts of stuff. There's a lot of equipment and staff there that you'll (hopefully) never need in a hernia repair. But you pay for it in that $6K. Not really fair, from your perspective, as your wife has no designs on making use of the neurosurgeon's microscope or heart surgeon's cardiac bypass machine, but that stuff is there and someone's gotta pay for it in the end. That's part of the reason why the cost is so ridiculously high, even for comparatively dinky stuff like an outpatient hernia surgery.

By the way, the equipment for a laparoscopic hernia repair isn't cheap. A couple thousand bucks (less than $10K) would probably pay for all the surgical equipment used in a traditional open hernia repair. With a laparoscopic repair, that television and camera equipment, gas insufflation equipment, special laparoscopic instruments, etc. will run probably 10-20x that.

At a surgicenter, the overhead is a lot less. Mainly that's because the patients tend to be not as sick, and the procedures not as involved. That translates to less staffing, less specialized equipment, etc. Because you don't have to plan for every possible surgical emergency known to man in a surgicenter, it's a lot cheaper to run that kind of place. So the cost savings gets passed on to the consumer. Insurance companies reimburse surgicenters less than what they pay hospitals (even for the same procedure). Your surgeon may or may not operate at a surgicenter.

Overall, the total price you're paying isn't too far off what I've heard for cash pay hernia repairs. I would have guessed about $5-7K at a surgicenter.

Not that any of that makes you feel any better about the deal. But in the end, hope it all works out great for your wife.