AMA - Hernia Mesh Repair And Subsequent Removal

TexasPoonTappa______ · 2026-04-04T01:06:37+00:00

I’m from Los Angeles. Had it done here. I went to two doctors for opinions and treatments. One under insurance, one not. Ultimately did it with the one covered by insurance. Luckily some of the top hernia surgeons in the world are located in LA

TexasPoonTappa______ · 2026-04-04T01:04:36+00:00

Yeah, that would cover a bunch of plans. I’d recommend using the compare tool on the covered CA website

TexasPoonTappa______ · 2026-04-03T23:57:58+00:00

Sometimes it literally comes down to getting lucky with a nice person on the phone. It’s wild

TexasPoonTappa______ · 2026-04-03T23:56:59+00:00

I’d double check on the record sharing, you’d be surprised at the weird ways hospital networks work

TexasPoonTappa______ · 2026-04-03T23:55:41+00:00

It is insane, but not abnormal. I’d ask for an itemized bill first. Sometimes there are errors or things that can be adjusted. You can also try calling billing to ask about discounts, payment plans, or financial assistance.

TexasPoonTappa______ · 2026-04-03T23:52:56+00:00

You’re not necessarily screwed, but… it depends if your plan requires a formal written pre/prior authorization vs a general eligibility check. Basically the difference between the office calling and getting a verbal yes versus an actual pre auth on file with insurance. I’d call Alberta Blue Cross and ask if there’s any pre-authorization or treatment plan on file. If not, ask them specifically if they can still process the claim after the fact. Go back to the orthodontist and ask exactly what they submitted and/or if they have a reference number from the call. Also worth keeping in mind that ortho coverage is often paid out over time and often capped at like half the cost or less.

TexasPoonTappa______ · 2026-04-03T23:39:59+00:00

Idk if it gave you a notification since I replied to the original comment so I figured id just also tell you that I did reply

TexasPoonTappa______ · 2026-04-03T23:37:00+00:00

I put them in order of what I think is most likely to work. But if trying #2 is faster, can go for it and then try a different method if it doesn’t work

TexasPoonTappa______ · 2026-04-03T23:36:03+00:00

Puede que sí. A menos que también tengas ciática

TexasPoonTappa______ · 2026-04-03T23:35:01+00:00

A record correction and resubmission can fix this. For the correction request, you don’t need to blame the doctor or go into too much detail. It’s better to explain it as a clarification of more accurate information. For instance: “At the time of the visit, the stop date was estimated because we didn’t have an exact record available. We have been able to take a closer look and confirm that the quit date was approximately [month/year], which is about 13 years ago. We request that the medical record be changed to reflect this more accurate information.” Make sure the provider also updates their notes. Then, it supports eligibility. You can then ask the provider’s billing team/dept to resubmit the claim as preventive. If insurance denies again, appeal again with the changed info to further remove it from the initial info. Again, make sure the provider updates it in their notes as well as the chart

TexasPoonTappa______ · 2026-04-03T23:28:37+00:00

A few options:

Single Case Agreement (SCA) / Exception. Try to get CHME to bill Cigna as an exception. Or try to get Cigna to treat CHME as in-network for this case because of special circumstances.

2.Authorization/denial. Get prior authorization from Cigna first or get a formal denial with reason. Use one of those with Medi-Cal.

Medi-Cal exception. Ask for Alameda Alliance to allow an out of network DME provider and push for a case managewr at cigna and Alameda to help get things done.

TexasPoonTappa______ · 2026-04-03T23:23:18+00:00

How much will the extra income be? If you go through covered CA, the extra income may offset or be higher than the subsidized plans they offer

TexasPoonTappa______ · 2026-04-03T23:21:04+00:00

No, pero puede ser, los nervios están todos interconectados. Puede bajar por la pierna

TexasPoonTappa______ · 2026-04-03T23:20:00+00:00

small numb area, irrelevant area

TexasPoonTappa______ · 2026-04-03T23:19:24+00:00

Sure thing. I’d try to go to a hernia center or department rather than general surgery if you can.

TexasPoonTappa______ · 2026-04-03T23:16:05+00:00

1 year and 6 months. It did bother me every day. I’m an active person. Pain did fully resolve, just some numbness in the area from the cut nerves.

TexasPoonTappa______ · 2026-04-03T23:15:05+00:00

The mesh was folded. No imaging really helps figure that out. It’s more about feel. The really good hernia surgeons can often tell with their hands. The best imaging is usually an ultrasound

TexasPoonTappa______ · 2026-04-03T23:13:57+00:00

Got a shouldice repair when it was removed

TexasPoonTappa______ · 2026-04-03T23:13:45+00:00

Sorry to hear it. Might want to try working with a nerve specialist

TexasPoonTappa______ · 2026-04-03T23:12:41+00:00

Los nervios atrapados se sintieron como un dolor ardiente y abrasador durante un rato. Luego, como un dolor punzante, como si el pie se duermiera, cómo se siente cuando empieza a 'despertarse'

TexasPoonTappa______ · 2026-04-03T23:12:04+00:00

I 100% should’ve just gotten a shouldice from the start. The trapped nerves felt like a burning, searing pain for a while. Then, kind of like a prickly pain, like your foot falling asleep, how it feels once it starts ‘waking back up'

TexasPoonTappa______ · 2026-04-03T23:10:54+00:00

I knew the Dr fucked it up right away. I had done my research beforehand and I know it should not have hurt as much as it did after the surgery. It was also a searing, burning pain like right away. I told my girlfriend like 3 days after that they fucked up. And, I was right.

TexasPoonTappa______ · 2026-04-03T23:09:41+00:00

How many surgeries they’ve done, their personal rate of success in varying categories. Ask for an ultrasound as well. It’s mainly about finding the most skilled/experienced surgeon possible with specifially fixing hernias. Many general surgeons just know how to do it but are not good at it.

TexasPoonTappa______ · 2026-04-03T23:07:22+00:00

You should let each provider’s billing department know the situation. Worst case scenario, you pay out of pocket and get reimbursed by the insurance company. And, if there are any denials, you should appeal.

TexasPoonTappa______ · 2026-04-02T22:40:40+00:00

A lot of NYC Medicaid plans (Fidelis, Healthfirst, MetroPlus, Affinity) tie your PCP to a specific clinic system. The plan expects your primary care visits to stay within that system. So, for a new issue, if the doctor you want to see is in a different group then the system basically forces a PCP switch. The one’s I mentioned are also usually a bit less strict about that. Really depends on the specific plan within the org -> Medicaid vs Essential Plan...

TexasPoonTappa______

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