I have had four C-sections and have a few areas in my muscle wall that need to be repaired, beyond cosmetic issues. I am only about 10 pounds over my ideal weight but most of it is in my tummy. Will insurance cover any of the expense due to muscle damage?
Insurance Coverage for Muscle Repair from C-sections Damage?
Doctor Answers (10)
Insurance Coverage for Muscle Prepare after C-section?
Thank you for the question and congratulations on your weight control.
It would be in your best interests to be examined by well experienced board-certified plastic surgeons who can then further guide you. Generally, it is becoming more and more difficult to obtain insurance coverage but if there is “muscle damage” or herniation is present, then this may be possible.
Abdominal Wall Hernia
If you have an abdominal wall hernia, then insurance will cover this. But what they wont cover is thightening of the abdominal wall and excision of the skin, i.e. abdominoplasty. You need to see a general surgeon to see if you have a hernia that needs to be fixed.
Hernia or not
Insurance companies will provide coverage for repair of an abdominal wall hernia if one exists. More commonly, however, there is not hernia but a weakness in the abdominal wall called a rectus diastasis. While this may be distressing it posed not health concerns and is therefore not a deformity typically covered by you health insurance provider. As for performing a tummy tuck when an abdominal wall hernia is repaired, this is certainly feasible and often convenient. Its repair, however, does not require that a tummy tuck be performed so don't expect that they will authorize coverage of the tummy tuck. Most likely, you will need to pay out of pocket for the tummy tuck while costs for the repair of a hernia would be covered. If no hernia exists, don't expect your insurance carrier to provide any degree of coverage no matter how damaged the muscles are.
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A hard sell
This smells a lot like a tummy tuck, and insurance will smell it too. It of course depends on the medical necessity. This would include hernia etc. Insurance companies are very difficult.
Insurance covers the muscle, not the tummy tuck.
Insurance will cover the muscle repair, but not the tummy tuck. The muscle can be repaired without the tummy tuck, so it is separate and considered cosmetic. And usually the insurance does not pay a lot toward the whole procedure. So look at it as a cosmtic procedure (you pay) with a litle help of the insurance company.
Call your insurance company.
I have not had any success in getting insurance to cover an abdominoplasty. I always repair the muscles that have spread apart from pregnancy. There is a difference between a true hernia and a diastasis recti.
Muscle damage and tummy tuck
Hi, most insurance plans will only cover hernia repairs in the abdomen. They will not cover surgery for any additional removal of fat or skin. You should see a plastic surgeon to clarify the exact procedure you would need to have done, and at that time your insurance company could determine whether or not this would be covered. Good luck, /nsn.
Insurance coverage for abdominal operations
If the muscle damage has resulted in hernias, then insurance should cover this surgery. If you're looking to tighten the muscles and remove some excess skin and fat, then insurance may deny this as being considered a tummy tuck. However, if you do have a hernia and want a cosmetic tummy tuck at the same time, the insurance coverage will help defray some anesthesia and facility fees. Be sure to check out some before and after photos if you do want a tummy tuck to see what results you can expect.
Insurance coverage after C-section
Insurance may cover problems associated with a c-section scar. A separation of the muscles is usually not enough to qualify for coverage unless something else is going on. Most commonly if there is a disruption of the anterior abdominal wall otherwise known as a hernia, this would be covered. If the scar was painful, thick and raised such as would occur with a keloid scar this would be covered. Lastly if you are developing a rash under the scar from overhanging skin this may be covered.
With any planned procedure predetermination is necessary to determine benefits of your insurance plan.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.