Insurance Coverage for Muscle Repair from C-sections Damage?

Hello! Thank you for your question! Surgical procedures for aesthetic
purposes, to improve appearance, are not covered by insurance.
Typically, these as well as complications resulting from such procedures
are the responsibility of the patient. Procedures that are meant to
correct functional issues and those which cause health-related issues
should be covered by your insurance as a medical necessity, with proper
examination and documentation. Some insurance plans have exclusion
criteria for certain procedures. Also, it is an obligation of the
surgeon not to attempt to authorize purely cosmetic procedures through
insurance. Discuss your issues and
complaints with a board-certified plastic surgeon to discuss these as
well as to examine and assist you in deciding which procedure(s) will be
the best for you. A discussion of the advantages and disadvantages will
take place along with the risks and benefits. Insurance companies will
vary on coverage and is always reasonable to discuss your issues with
your surgeon and primary care. It would behoove you to get as much
information as possible and even call your insurance yourself.
Certainly, pay in advance prior to your surgical procedure and options
such as financing are available if you qualify. Hope that this helps!
Best wishes!

Unfortunately, insurance does not cover a tummy tuck. Occasionally with documentation of recurrent infection they will pay for a panniculectomy (simply removing loose skin).#tt#tummytuck

In my practice this is a very common question as it would
seem likely that restoring the body after pregnancy would be medically
necessary especially since pregnancy can cause diastasis of the abdominal
muscles.  A diastasis is a slight
separation of muscle that can cause abdominal laxity which can be furthered strained
after c-section procedures leaving some women with a “pouch” in the lower
abdomen.  The only way to improve the
diastasis and tighten the abdominal muscles is with an abdominoplasty.  Unfortunately, insurance companies do not cover
abdominoplasty procedures because they do not consider repairing a diastasis as
a reconstructive procedure regardless of what the cause of the muscle
separation may be.  To be considered a reconstructive procedure, a
procedure needs to restore functionality, correct a deformity, or repair a
defect like a hernia.  A hernia involves
a complete separation of muscle that allows the internal organs to protrude into
the abdomen.  For patients who have a history
of multiple failed hernia repairs, abdominal wall reconstruction can be done to
close the defect and reinforce the abdominal muscles.  However, abdominal wall reconstruction does
not tighten all of the abdominal muscles or remove large amounts of excess
tissue like a tummy tuck.  Typically
after pregnancy, women require a tummy tuck to restore their pre-pregnancy
bodies but without a physical examination it is difficult to provide an opinion
as to which procedure is best for you.  I
recommend scheduling a consultation with a board certified plastic surgeon to
receive a customized surgical plan to help you achieve your pre-pregnancy look.Be well and good luck!@norrisplastic