Question 1

Will insurance cover my evaluation and surgery?

Accepted Answer

We work with most major insurance plans to provide you care. Complex hernia surgery and abdominal wall reconstruction are typically covered as medically necessary procedures when properly documented. Our intake team will work with you and your insurance provider to verify coverage before any clinical engagement begins. We encourage you to submit your case and include your insurance information so our affiliated team can assist with verification.

Question 2

What insurance plans do you work with?

Accepted Answer

We work with most major private insurance plans, including Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, Oxford, Empire BlueCross, Emblem Health, and others. Coverage for specific procedures varies by plan and individual policy. Our team will help clarify your benefits as part of the intake process.

Question 3

What if my insurance denies coverage for a complex hernia repair?

Accepted Answer

Insurance denials for complex hernia surgery are not uncommon, particularly for advanced procedures like component separation or mesh explantation. Our affiliated surgeons and their teams are experienced in the appeals process and can provide the clinical documentation needed to support medical necessity determinations. We encourage you to submit your case regardless of prior denial — many patients successfully obtain coverage after appeal.

Question 4

Will I need prior authorization before surgery?

Accepted Answer

Most insurance plans require prior authorization for elective surgical procedures, including complex hernia repair. This process is initiated after a formal clinical evaluation by an affiliated physician. The authorization process typically requires operative reports from prior surgeries, imaging studies, and a letter of medical necessity. Our affiliated surgical team manages this process routinely.

Question 5

How do I send my CT scan for review?

Accepted Answer

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Question 6

What type of imaging is most useful for surgeon review?

Accepted Answer

A CT scan of the abdomen and pelvis with IV contrast is the most informative study for evaluating complex hernias, mesh complications, and abdominal wall defects. It allows our affiliated surgeons to assess defect size, mesh position and integrity, bowel involvement, and tissue quality — all critical for surgical planning. If you have MRI studies or prior operative reports, those are also helpful and should be included.

Question 7

What if I don't have imaging yet?

Accepted Answer

You can still submit your case without imaging. Our team will review your surgical history and symptoms and may recommend specific imaging studies as part of the evaluation process. In some cases, we can assist with coordinating imaging at a facility near you. Do not let the absence of imaging prevent you from reaching out.

Question 8

Is my imaging and personal information kept confidential?

Accepted Answer

Yes. All imaging and personal health information submitted through this site is handled with strict confidentiality. Data is transmitted through encrypted, secure channels and is accessible only to affiliated physicians for the purpose of case review. We apply HIPAA-aligned standards to all intake data and imaging submissions. Please review our Privacy Policy for full details.

Question 9

What happens after I submit my case?

Accepted Answer

After you submit your intake form, your case is routed directly to our affiliated surgical team for review. An affiliated surgeon or their clinical coordinator will contact you within 24–48 hours to discuss your case, answer questions, and determine whether an in-person or telehealth evaluation is appropriate. If you have uploaded imaging, the surgeon will review it prior to contacting you so the conversation is focused and productive.

Question 10

How quickly will I hear back?

Accepted Answer

Our goal is to respond to every inquiry within 24–48 hours. For urgent situations — such as suspected mesh infection, bowel obstruction symptoms, or wound breakdown — please call us directly at (866) HERNIA-6 · (866) 437-6426 rather than waiting for a form response. If your situation is a medical emergency, call 911 or go to your nearest emergency room immediately.

Question 11

Will I have a virtual or in-person evaluation?

Accepted Answer

This depends on your situation and location. Many initial consultations can be conducted via telehealth, particularly when imaging is available for review in advance. An in-person evaluation is typically required before any surgical planning is finalized. Our affiliated surgeons operate at multiple hospital and surgery center locations across the New York metropolitan area.

Question 12

Does submitting this form mean I am a patient?

Accepted Answer

No. Submitting this form is for educational inquiry purposes only and does not establish a physician-patient relationship. A physician-patient relationship is established only through a formal clinical engagement with an independently licensed physician affiliated with Town Surgery NY PLLC, with the physician's explicit agreement to provide care and your informed consent to receive it.

Question 13

Do I need a referral from my doctor to be evaluated?

Accepted Answer

No referral is required to submit your case for educational review. Patients can contact us directly. However, if you have a primary care physician or surgeon who is managing your care, we encourage you to inform them of your inquiry and, if possible, obtain copies of your operative reports and imaging before reaching out. This information significantly accelerates the review process.

Question 14

Can my surgeon refer me directly?

Accepted Answer

Yes. We welcome direct referrals from general surgeons, primary care physicians, and other specialists managing patients with complex hernia complications. Referring physicians can submit cases through the same intake form, selecting 'Referring Physician' as the inquiry type. Please include operative reports, imaging, and relevant clinical history. We provide timely case consultation and communicate findings back to the referring provider.

Question 15

I was told my case is inoperable. Should I still reach out?

Accepted Answer

Absolutely. This program exists specifically for patients who have been told their case is too complex, too high-risk, or inoperable. Our affiliated surgeons evaluate cases that other programs decline. Being told 'no' elsewhere is not the end of the road — it is often the beginning of finding the right team. Submit your case and let our surgeons make an independent assessment.

Question 16

I am a physician managing a patient with a complex hernia complication. How do I refer?

Accepted Answer

Use our intake form and select 'Referring Physician' as the inquiry type. Please include the patient's operative history, current imaging (CT abdomen/pelvis with contrast is most useful), and a brief clinical summary. Our affiliated surgeons review referrals within 24–48 hours and will contact you directly to discuss the case. For urgent referrals, please call (866) HERNIA-6 · (866) 437-6426.

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