1. Preparation
WHAT ARE HERNIAS AND HYDROCOELES?
Hernia – A hernia is the protrusion of an organ or tissue through an abnormal opening. A hiatus hernia is very different in nature and treatment than the hernias described below, and therefore will not be discussed in this section.
Most hernias occur when the intestines protrude through a weakness in the abdominal muscles. This weakness can be present from birth or develop over time. Risk factors that may contribute to the development of a hernia include obesity, pregnancy, constipation, and heavy lifting. Symptoms you may experience include a lump or swelling in the affected area, pain that is often exacerbated by lifting or straining (such as when going to the toilet), digestive problems such as nausea or constipation.
Most hernias are harmless, although there is always the potential that the hernia will become ‘strangulated’, which means the portion of bowel pushed through the opening becomes cut off from its blood supply and will therefore die. The only way to permanently repair a hernia is with a surgical procedure, which is one of the most common operations performed in Australia. Hernias are classified by their position in the body:
-
Inguinal hernia – This is the most common type of hernia, and is more common in men than women. The intestines push through a weak spot in the inguinal canal. The inguinal canal is a triangular shaped opening between the layers of abdominal muscles near the groin.
-
Femoral hernia – Much like the inguinal hernia, the femoral hernia appears in the groin area, developing near the leg crease. It occurs in the triangle shaped gap between the inguinal ligaments, the lower side of the pubic bone and the femoral vein. Because of the angle and shape of the pelvis, this type of hernia is more common in females. This type of hernia is the most likely to become strangulated.
-
Incisional hernia – Also known as a ventral hernia, this is when the bowel pushes through an incision made during previous abdominal surgery. The site of an operation is always structurally weaker than the surrounding area, leading to a susceptibility for hernia development.
-
Umbilical and paraumbilical hernia –This type of hernia is most common in newborn babies. It is caused by a weakness of the abdominal wall in the area around the navel. In some cases these kinds of hernias close naturally but if they do not, they may require surgical repair.
Hydrocoele – A hydrocoele is a bag which fills with fluid and appears in one or both sides of the scrotum. Hydrocoeles are common in newborn babies but normally vanish a few months after birth. In normal development the testicles move down a tube from the abdomen into the scrotum. A hydrocoele occurs when the tube does not close and fluid drains from the abdomen into the scrotum and becomes trapped. This causes an enlargement of the scrotum.
A hydrocoele can also be caused by trauma or inflammation to the testicle; this type of hydrocele is more common in older men. In most cases hydrocoeles are painless and not dangerous, only requiring treatment should they become uncomfortable or embarrassing.
In rare cases, hydrocoeles can become so large that they may block the blood supply to the testicles.
HOW DO I CHOOSE A SPECIALIST?
Your GP, or the doctor you first consult, will be able to recommend and refer you to a General Surgeon who can perform the procedure.
You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. These are often good organisations to turn to for information about what you can expect from your medical specialist, and how to locate a specialist in your area. You can access the Royal Australasian College of Surgeons at www.surgeons.org,
The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital a particular doctor operates from and what their fees are. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website)
To access a list of General Surgeons who participate in HCF’s Medicover no gap arrangement:
Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.
WHAT SHOULD I ASK MY SPECIALIST?
-
Make sure you fully understand the procedure that is planned; do not be afraid to ask. It is your right to know all the relevant information, as this is part of informed clinical consent. Your doctor will ask you to sign a consent form which you should fully understand.
-
What are your likely out of pocket medical expenses? Your doctor should be able to give you a breakdown of any costs you will incur – this is known as Informed Financial Consent.
-
Are they skilled in both open and laparoscopic surgical techniques? What is the best option recommended for you personally?
-
What is the risk of recurrence following surgery?
-
In addition to what the procedure entails, you should also ask about:
-
-
Follow up appointments, jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
-
-
Most medication should be continued as usual, but some may interfere with the operation. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
-
Aspirin (or any related products),
-
Blood thinners (Warfarin, heparin.),
-
Arthritis medication,
-
Pain medication,
-
Insulin
Always remember to tell your doctor what medication you are taking and don’t forget to include any herbal remedies or alternative medicines as these too may have interactions and side effects.
WHERE IS IT DONE?
Both hernia and hydrocoele repair is done in either a specialised day surgery, or in the day surgery department of an overnight hospital.
HOW LONG IS THE PROCEDURE?
The length of time it takes to repair a hernia varies depending on the size and severity, but generally, you will be in surgery for one to two hours.
Theatre time for repair of a hydrocoele is approximately 30 minutes.
WHO IS INVOLVED?
-
A general surgeon
-
Depending on the extent of the operation, your surgeon may require an assistant surgeon
-
Anaesthetist, who will administer the anaesthetic and look after you whilst the procedure is being performed
-
Nurses, who assist with the procedure and look after you whilst you recover
-
Pathologist, if any blood tests are necessary
HOW DO I PREPARE FOR THE PROCEDURE?
Because the hernia or hydrocele repair will probably be done under a general anaesthetic (albeit a relatively short one), you may need to undergo some basic tests to ensure your overall health is suitable for the procedure. This will depend on your age and health, and could include such things as an ECG (recording of your heart rhythm), chest x-ray and blood tests.
Your doctor will probably ask you to stop taking any aspirin and anti-inflammatory medication prior to surgery to ensure they are out of your bloodstream. This allows for bleeding and clotting times to return to normal.
You will normally be required to fast for 6 hours prior to the procedure.
Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed.
WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?
-
Any recent, relevant x-rays or scans
-
Do not bring any valuables with you
-
Leave all jewellery at home (wedding rings are acceptable)
-
Comfortable clothes to go home in
-
Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
-
Remove all nail polish and do not wear any make-up
-
Toiletries and nightclothes
-
Men should bring firm underpants
-
You may want something to read whilst you wait
2. Costs and Charges
WHAT IS IT GOING TO COST?
Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.
HERNIAS & HYDROCOELES (OPEN REPAIR)
For your information, the average charges for claims paid for Open Repair of Hernia and Hydrocoele admissions for the financial year 06/07 are provided below:
|
|
On Average
|
|
|
Charge
|
Medicare Pays
|
HCF Pays
|
3
If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement
|
4
If your doctor USES HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor USES HCF’s No Gap Arrangement
|
|
Total Average Hospital Component (accommodation, theatre and hospital related services)
|
$1,782
|
|
$1,780
|
|
|
|
|
|
1
Medical Services Component
|
|
|
|
|
|
|
|
|
Anaesthetic Services
|
$375
|
$141
|
$48
|
$258
|
41.7%
|
$0
|
58.3%
|
|
Assistant in Operations Services
|
$137
|
$60
|
$21
|
$95
|
44.0%
|
$0
|
56.0%
|
|
General Surgical Services
|
$690
|
$315
|
$107
|
$441
|
36.2%
|
$0
|
63.8%
|
|
2
Total Average Medical Services
|
$1,104
|
$475
|
$161
|
$545
|
51.3%
|
$0
|
48.7%
|
|
Hospital and Medical Services Average for Open Repair of Hernia and Hydrocoele Admissions
|
$2,886
|
$475
|
$1,941
|
$545
|
51.3%
|
$0
|
5
48.7%
|
Points to Note:
-
Charges are based on HCF claims for a sample size of 298 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare items 30612, 30614, 30620 and 30621.
-
As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
-
There is no excess payable for same day admissions.
1 These medical services are in-patient services only.
2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. specialist consultation. Therefore, the total average medical service charge ($1,104) differs from the sum of the individual average charges as shown.
3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.
4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.
HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.
5 This percentage indicates the total coverage of hospital and medical services for all open repair of hernias and hydrocoeles. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.
HERNIAS (LAPAROSCOPIC REPAIR)
For your information, the average charges for claims paid for Laparoscopic Repair of Hernia admissions for the financial year 06/07 are provided below:
|
|
On Average
|
|
|
Charge
|
Medicare Pays
|
HCF Pays
|
3
If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement
|
4
If your doctor USES HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor USES HCF’s No Gap Arrangement
|
|
Total Average Hospital Component (accommodation, theatre and hospital related services)
|
$2,594
|
|
$2,586
|
|
|
|
|
|
1
Medical Services Component
|
|
|
|
|
|
|
|
|
Anaesthetic Services
|
$510
|
$181
|
$60
|
$314
|
64.8%
|
$0
|
35.2%
|
|
Assistant in Operations Services
|
$161
|
$72
|
$24
|
$107
|
50.5%
|
$0
|
49.5%
|
|
General Surgical Services
|
$920
|
$360
|
$120
|
$600
|
62.2%
|
$0
|
37.8%
|
|
2
Total Average Medical Services
|
$1,535
|
$590
|
$197
|
$751
|
81.1%
|
$0
|
18.9%
|
|
Hospital and Medical Services Average for Laparoscopic Repair of Hernia Admissions
|
$4,129
|
$590
|
$2,783
|
$751
|
81.1%
|
$0
|
5
18.9%
|
Points to Note:
-
Charges are based on HCF claims for a sample size of 111 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 30609.
-
As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
-
There is no excess payable for same day admissions.
1 These medical services are in-patient services only.
2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. specialist consultation. Therefore, the total average medical service charge ($1,535) differs from the sum of the individual average charges as shown.
3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.
4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.
HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.
5 This percentage indicates the total coverage of hospital and medical services for all laparoscopic repair of hernia admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.
3. Day of procedure
WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?
When you arrive at the hospital or day surgery, the admissions clerk will attend to the paperwork associated with your stay.
On admission to the hospital a nurse will orientate you to your surroundings and perform a series of basic tests and observations. They will usually check your medical history, confirm your medication and ask about any known allergies. Please remember to mention any herbal or homeopathic remedies you may be taking, as these can have interactions and side effects too.
The consent form for the operation, if not already completed, should be attended to by your surgeon.
An anaesthetist will visit you prior to your operation. He/she will discuss with you what type of anaesthetic will be used throughout the procedure. They will also discuss the type of pain relief you will require after the operation; usually you will be given relatively strong tablets to take home with you.
A general anaesthetic is normally used for both repair of a hernia and hydrocoele surgery, so this means that you will be asleep during the procedure.
WHAT CAN I EXPECT DURING A HERNIA OR HYDROCOELE REPAIR?
You will be taken from the ward area to the anaesthetic bay of the operating theatre. If not already inserted, a small plastic tube called a cannula will be placed into a vein in your arm or hand. If having a general anaesthetic, the cannula is used to administer intravenous sedation, which is the first stage of your anaesthetic. You won’t remember anything more until you wake up in the recovery unit. Once the anaesthetic has taken effect, you will be moved into the operating theatre for surgery.
Hernia - The procedure will differ based on the type and location of the hernia, and to some extent the preference of the surgeon. Two main types of operation exist: laparoscopic (keyhole), and open repair. Laparoscopic repair is used predominantly (although not exclusively) for inguinal and incisional hernias.
Laparoscopic repair
:
Three tiny cuts are made in the wall of the abdomen. A balloon dilating apparatus is put in and moved down to the pubic bone between the abdominal muscles and stomach lining.
The balloon is inflated to separate the lining from the layer of muscle. After this has been done, the balloon is removed and replaced with a tube called a laparoscopic port and the area is expanded with water and a telescope is put into the space. The possibility of adhesions or damage being done to the organs of the stomach is greatly reduced due to the fact that the abdominal cavity is not entered.
Two more minute incisions are made. These are made on the opposite side of the hernia between the umbilicus and pubic bone. This is to make room for the surgical instruments that are to be used for the procedure. A space is created so that the defect of the muscle can be seen clearly. The hernia is then pulled back into the space and a piece of flexible mesh is guided down the port and put in place to cover the weak areas and held in place by tacking devices. There are generally about 10 tacking devices used. Anaesthetic is then put into the space before the surgeon withdraws the ports.
The pressure in the cavity of the abdomen pushes onto the mesh and traps it, holding it in place. With any straining or increase in pressure in the abdomen, the mesh is pressed firmly against the abdominal wall, therefore, providing protection from the repair pulling apart. The small incisions are then closed with dissolving stitches.
This method is not as painful as open repairs and recovery times are generally shorter as it is far less invasive.
Open repair
:
This involves making an incision through the skin, outer layer of the abdominal wall and muscle overlying the area. The size of the incision obviously depends on the size and position of the hernia. As with the laparoscopic technique, your surgeon will usually use a mesh to reinforce the weak abdominal wall. This is stitched or stapled into place without tension, and is therefore known as a tension free repair. Older techniques involved tightly stitching together the area, which lead to longer recovery times and a higher rate of hernia recurrence.
Hydrocoele – The area of the groin is cleaned with an antiseptic solution. A small incision is made in the groin on the side of the hydrocoele. The blood vessel leading to the testis and the tube that carries sperm from the testicle to the penis are freed up from the surrounding tissues. The pocket of abdominal lining is separated out and tied off. The fluid is then drained from around the testis.
Once this procedure is complete, the other tissues are returned to their normal position and the wound is sutured closed under the skin. In most cases absorbable sutures are used. The wound is then covered with a water resistant dressing.
1. Preparation
WHAT ARE HERNIAS AND HYDROCOELES?
Hernia – A hernia is the protrusion of an organ or tissue through an abnormal opening. A hiatus hernia is very different in nature and treatment than the hernias described below, and therefore will not be discussed in this section.
Most hernias occur when the intestines protrude through a weakness in the abdominal muscles. This weakness can be present from birth or develop over time. Risk factors that may contribute to the development of a hernia include obesity, pregnancy, constipation, and heavy lifting. Symptoms you may experience include a lump or swelling in the affected area, pain that is often exacerbated by lifting or straining (such as when going to the toilet), digestive problems such as nausea or constipation.
Most hernias are harmless, although there is always the potential that the hernia will become ‘strangulated’, which means the portion of bowel pushed through the opening becomes cut off from its blood supply and will therefore die. The only way to permanently repair a hernia is with a surgical procedure, which is one of the most common operations performed in Australia. Hernias are classified by their position in the body:
-
Inguinal hernia – This is the most common type of hernia, and is more common in men than women. The intestines push through a weak spot in the inguinal canal. The inguinal canal is a triangular shaped opening between the layers of abdominal muscles near the groin.
-
Femoral hernia – Much like the inguinal hernia, the femoral hernia appears in the groin area, developing near the leg crease. It occurs in the triangle shaped gap between the inguinal ligaments, the lower side of the pubic bone and the femoral vein. Because of the angle and shape of the pelvis, this type of hernia is more common in females. This type of hernia is the most likely to become strangulated.
-
Incisional hernia – Also known as a ventral hernia, this is when the bowel pushes through an incision made during previous abdominal surgery. The site of an operation is always structurally weaker than the surrounding area, leading to a susceptibility for hernia development.
-
Umbilical and paraumbilical hernia –This type of hernia is most common in newborn babies. It is caused by a weakness of the abdominal wall in the area around the navel. In some cases these kinds of hernias close naturally but if they do not, they may require surgical repair.
Hydrocoele – A hydrocoele is a bag which fills with fluid and appears in one or both sides of the scrotum. Hydrocoeles are common in newborn babies but normally vanish a few months after birth. In normal development the testicles move down a tube from the abdomen into the scrotum. A hydrocoele occurs when the tube does not close and fluid drains from the abdomen into the scrotum and becomes trapped. This causes an enlargement of the scrotum.
A hydrocoele can also be caused by trauma or inflammation to the testicle; this type of hydrocele is more common in older men. In most cases hydrocoeles are painless and not dangerous, only requiring treatment should they become uncomfortable or embarrassing.
In rare cases, hydrocoeles can become so large that they may block the blood supply to the testicles.
HOW DO I CHOOSE A SPECIALIST?
Your GP, or the doctor you first consult, will be able to recommend and refer you to a General Surgeon who can perform the procedure.
You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. These are often good organisations to turn to for information about what you can expect from your medical specialist, and how to locate a specialist in your area. You can access the Royal Australasian College of Surgeons at www.surgeons.org,
The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital a particular doctor operates from and what their fees are. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website)
To access a list of General Surgeons who participate in HCF’s Medicover no gap arrangement:
Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.
WHAT SHOULD I ASK MY SPECIALIST?
-
Make sure you fully understand the procedure that is planned; do not be afraid to ask. It is your right to know all the relevant information, as this is part of informed clinical consent. Your doctor will ask you to sign a consent form which you should fully understand.
-
What are your likely out of pocket medical expenses? Your doctor should be able to give you a breakdown of any costs you will incur – this is known as Informed Financial Consent.
-
Are they skilled in both open and laparoscopic surgical techniques? What is the best option recommended for you personally?
-
What is the risk of recurrence following surgery?
-
In addition to what the procedure entails, you should also ask about:
-
-
Follow up appointments, jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
-
-
Most medication should be continued as usual, but some may interfere with the operation. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
-
Aspirin (or any related products),
-
Blood thinners (Warfarin, heparin.),
-
Arthritis medication,
-
Pain medication,
-
Insulin
Always remember to tell your doctor what medication you are taking and don’t forget to include any herbal remedies or alternative medicines as these too may have interactions and side effects.
WHERE IS IT DONE?
Both hernia and hydrocoele repair is done in either a specialised day surgery, or in the day surgery department of an overnight hospital.
HOW LONG IS THE PROCEDURE?
The length of time it takes to repair a hernia varies depending on the size and severity, but generally, you will be in surgery for one to two hours.
Theatre time for repair of a hydrocoele is approximately 30 minutes.
WHO IS INVOLVED?
-
A general surgeon
-
Depending on the extent of the operation, your surgeon may require an assistant surgeon
-
Anaesthetist, who will administer the anaesthetic and look after you whilst the procedure is being performed
-
Nurses, who assist with the procedure and look after you whilst you recover
-
Pathologist, if any blood tests are necessary
HOW DO I PREPARE FOR THE PROCEDURE?
Because the hernia or hydrocele repair will probably be done under a general anaesthetic (albeit a relatively short one), you may need to undergo some basic tests to ensure your overall health is suitable for the procedure. This will depend on your age and health, and could include such things as an ECG (recording of your heart rhythm), chest x-ray and blood tests.
Your doctor will probably ask you to stop taking any aspirin and anti-inflammatory medication prior to surgery to ensure they are out of your bloodstream. This allows for bleeding and clotting times to return to normal.
You will normally be required to fast for 6 hours prior to the procedure.
Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed.
WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?
-
Any recent, relevant x-rays or scans
-
Do not bring any valuables with you
-
Leave all jewellery at home (wedding rings are acceptable)
-
Comfortable clothes to go home in
-
Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
-
Remove all nail polish and do not wear any make-up
-
Toiletries and nightclothes
-
Men should bring firm underpants
-
You may want something to read whilst you wait
2. Costs and Charges
WHAT IS IT GOING TO COST?
Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.
HERNIAS & HYDROCELES (OPEN REPAIR)
For your information, the average charges for claims paid for Open Repair of Hernia and Hydrocele admissions for the financial year 06/07 are provided below:
|
|
On Average
|
|
|
Charge
|
Medicare Pays
|
HCF Pays
|
3
If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement
|
4
If your doctor USES HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor USES HCF’s No Gap Arrangement
|
|
Total Average Hospital Component (accommodation, theatre and hospital related services)
|
$1,782
|
|
$1,780
|
|
|
|
|
|
1
Medical Services Component
|
|
|
|
|
|
|
|
|
Anaesthetic Services
|
$375
|
$141
|
$48
|
$258
|
41.7%
|
$0
|
58.3%
|
|
Assistant in Operations Services
|
$137
|
$60
|
$21
|
$95
|
44.0%
|
$0
|
56.0%
|
|
General Surgical Services
|
$690
|
$315
|
$107
|
$441
|
36.2%
|
$0
|
63.8%
|
|
2
Total Average Medical Services
|
$1,104
|
$475
|
$161
|
$545
|
51.3%
|
$0
|
48.7%
|
|
Hospital and Medical Services Average for Open Repair of Hernia and Hydrocoele Admissions
|
$2,886
|
$475
|
$1,941
|
$545
|
51.3%
|
$0
|
5
48.7%
|
Points to Note:
-
Charges are based on HCF claims for a sample size of 298 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare items 30612, 30614, 30620 and 30621.
-
As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
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There is no excess payable for same day admissions.
1 These medical services are in-patient services only.
2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. specialist consultation. Therefore, the total average medical service charge ($1,104) differs from the sum of the individual average charges as shown.
3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.
4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.
HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.
5 This percentage indicates the total coverage of hospital and medical services for all open repair of hernias and hydrocoeles. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.
HERNIAS (LAPAROSCOPIC REPAIR)
For your information, the average charges for claims paid for Laparoscopic Repair of Hernia admissions for the financial year 06/07 are provided below:
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On Average
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|
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Charge
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Medicare Pays
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HCF Pays
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3
If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement
|
4
If your doctor USES HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor USES HCF’s No Gap Arrangement
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|
Total Average Hospital Component (accommodation, theatre and hospital related services)
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$2,594
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$2,586
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|
|
|
|
|
1
Medical Services Component
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|
|
|
|
|
|
|
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Anaesthetic Services
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$510
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$181
|
$60
|
$314
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64.8%
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$0
|
35.2%
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|
Assistant in Operations Services
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$161
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$72
|
$24
|
$107
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50.5%
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$0
|
49.5%
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|
General Surgical Services
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$920
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$360
|
$120
|
$600
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62.2%
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$0
|
37.8%
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|
2
Total Average Medical Services
|
$1,535
|
$590
|
$197
|
$751
|
81.1%
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$0
|
18.9%
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Hospital and Medical Services Average for Laparoscopic Repair of Hernia Admissions
|
$4,129
|
$590
|
$2,783
|
$751
|
81.1%
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$0
|
5
18.9%
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Points to Note:
-
Charges are based on HCF claims for a sample size of 111 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 30609.
-
As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
-
There is no excess payable for same day admissions.
1 These medical services are in-patient services only.
2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. specialist consultation. Therefore, the total average medical service charge ($1,535) differs from the sum of the individual average charges as shown.
3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.
4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.
HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.
5 This percentage indicates the total coverage of hospital and medical services for all laparoscopic repair of hernia admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.
3. Day of procedure
WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?
When you arrive at the hospital or day surgery, the admissions clerk will attend to the paperwork associated with your stay.
On admission to the hospital a nurse will orientate you to your surroundings and perform a series of basic tests and observations. They will usually check your medical history, confirm your medication and ask about any known allergies. Please remember to mention any herbal or homeopathic remedies you may be taking, as these can have interactions and side effects too.
The consent form for the operation, if not already completed, should be attended to by your surgeon.
An anaesthetist will visit you prior to your operation. He/she will discuss with you what type of anaesthetic will be used throughout the procedure. They will also discuss the type of pain relief you will require after the operation; usually you will be given relatively strong tablets to take home with you.
A general anaesthetic is normally used for both repair of a hernia and hydrocoele surgery, so this means that you will be asleep during the procedure.
WHAT CAN I EXPECT DURING A HERNIA OR HYDROCOELE REPAIR?
You will be taken from the ward area to the anaesthetic bay of the operating theatre. If not already inserted, a small plastic tube called a cannula will be placed into a vein in your arm or hand. If having a general anaesthetic, the cannula is used to administer intravenous sedation, which is the first stage of your anaesthetic. You won’t remember anything more until you wake up in the recovery unit. Once the anaesthetic has taken effect, you will be moved into the operating theatre for surgery.
Hernia - The procedure will differ based on the type and location of the hernia, and to some extent the preference of the surgeon. Two main types of operation exist: laparoscopic (keyhole), and open repair. Laparoscopic repair is used predominantly (although not exclusively) for inguinal and incisional hernias.
Laparoscopic repair
:
Three tiny cuts are made in the wall of the abdomen. A balloon dilating apparatus is put in and moved down to the pubic bone between the abdominal muscles and stomach lining.
The balloon is inflated to separate the lining from the layer of muscle. After this has been done, the balloon is removed and replaced with a tube called a laparoscopic port and the area is expanded with water and a telescope is put into the space. The possibility of adhesions or damage being done to the organs of the stomach is greatly reduced due to the fact that the abdominal cavity is not entered.
Two more minute incisions are made. These are made on the opposite side of the hernia between the umbilicus and pubic bone. This is to make room for the surgical instruments that are to be used for the procedure. A space is created so that the defect of the muscle can be seen clearly. The hernia is then pulled back into the space and a piece of flexible mesh is guided down the port and put in place to cover the weak areas and held in place by tacking devices. There are generally about 10 tacking devices used. Anaesthetic is then put into the space before the surgeon withdraws the ports.
The pressure in the cavity of the abdomen pushes onto the mesh and traps it, holding it in place. With any straining or increase in pressure in the abdomen, the mesh is pressed firmly against the abdominal wall, therefore, providing protection from the repair pulling apart. The small incisions are then closed with dissolving stitches.
This method is not as painful as open repairs and recovery times are generally shorter as it is far less invasive.
Open repair
:
This involves making an incision through the skin, outer layer of the abdominal wall and muscle overlying the area. The size of the incision obviously depends on the size and position of the hernia. As with the laparoscopic technique, your surgeon will usually use a mesh to reinforce the weak abdominal wall. This is stitched or stapled into place without tension, and is therefore known as a tension free repair. Older techniques involved tightly stitching together the area, which lead to longer recovery times and a higher rate of hernia recurrence.
Hydrocoele – The area of the groin is cleaned with an antiseptic solution. A small incision is made in the groin on the side of the hydrocoele. The blood vessel leading to the testis and the tube that carries sperm from the testicle to the penis are freed up from the surrounding tissues. The pocket of abdominal lining is separated out and tied off. The fluid is then drained from around the testis.
Once this procedure is complete, the other tissues are returned to their normal position and the wound is sutured closed under the skin. In most cases absorbable sutures are used. The wound is then covered with a water resistant dressing.
4. Aftercare
WHAT HAPPENS AFTER A HERNIA OR HYDROCOELE REPAIR?
You will wake up in the recovery room, where nursing staff will closely monitor your breathing and vital signs. You may have a facial mask or small tubes in your nostrils giving you extra oxygen until you are fully awake. Once you have recovered from the anaesthetic, you will then be taken to the ward area where you will rest until you are well enough to go home. You will need to have gone to the toilet and had something to eat and drink before being allowed to go home. In most cases, you will be able to go home the same day. You will not be able to drive and will need to be accompanied home. If this presents a problem for you please advise your doctor/hospital prior to admission.
Usually dissolvable stitches will be used and the wound will be covered with a dressing to keep it clean and protected.
Before discharge you should be given specific advice about how to look after yourself at home. You should be clear on the following issues:
You should also be advised of whom to contact if you experience any problems or are concerned. As a guide, you should seek further help if you experience any of the following symptoms:
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Swelling or redness around the incision
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Seepage or bloody discharge from the wound
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Fever and chills
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Swollen abdomen
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Pain that is not relieved by prescribed pain medication