An umbilical hernia repair is a relatively simple procedure usually performed by a general surgeon and only involves a small incision around your umbilicus. This may be covered by your insurance but is a much smaller procedure than a tummy tuck. A full tummy tuck involves a larger incision in your lower abdomen, raising the skin and fat off of the abdominal muscles. The rectus abdominous muscles which usually have spread apart from pregnancy are then sutured together. This gets rid of the abdominal bulge and often corrects small umbilical hernias. Insurance companies are all different in how they approach patients doing this kind of surgery and many plastic surgeons accept no insurance as the companies often deny payment for aesthetic surgery even if there is a functional component - so there is no easy answer to your question. If your plastic surgeon works with a general surgeon, then the general surgeons fee for the hernia repair might be covered, but you will have to pay the plastic surgeon. If your insurance company pays for the joint procedure then it is possible that part of the anesthesiologists and hospital charges may be covered
Depends on how good your insurance is.
William B. Rosenblatt, MD answers: Tummy tuck with muscle and hernia repair covered by insurance?
I need an umbilical hernia and abdominal muscle repair, and I would like to get a tummy tuck at the same time. I am pretty sure that my health insurance will cover the hernia repair. Is it possible for me to just pay the additional costs out of pocket for the tummy tuck portion of the surgery? Is this feasable? Would most surgeons agree to this? Thanks in advance for your insight!
A: Yes, yes, and yes
Donna B,
In a word or three, yes. Many surgeons, myself included, would be very accommodating to this type of request. Your biggest out of pocket concerns might be anesthesia and hospital fees if your surgery is performed in a hospital operating room. You can save a significant amount of money by having your surgery in an office operating room with a plastic surgeon that can perform both procedures. Some insurance carriers will cover anesthesia and operating room fees in this setting. Good luck!
Contact the doctorA: Medical costs are covered for medical issues
Although many insurance companies would have you believe that medical problems treated at the same time as a cosmetic procedure, this is more an attempt to not pay for your medical problem. At the least, they should pay for the medical treatments for the hernias, as well as the hospitalization and anesthesia bills. The last two bills may be prorated so as the pay only for that part of the procedure that is medical realted.
A: Tummy tuck and hernia
The hernia should be covered by insurance. The tummy tuck portion will not be covered. You will most likely have to pay for the extra OR time and anesthesia as welll as your surgeon's fee for the tummy tuck.
A: This is very feasable
There is no reason not to do the two procedures together and many plastic surgeons and general surgeons will work as a team to get this done. There may or may not be some savings. You and your doctors will need to work this out with the insurance co.
A: Yes, it is possible
In most cases the insurance will cover the hernia repair for the surgery. However, they will not cover the abdominoplasty surgeon fee or the operating room or anesthesia fees for the abdominoplasty. Patients often think that, "since I am in the operating room anyway, I will just get another procedure done." This is possible, but the insurance companies are no fools. They will cover the medically indicated part only.
The other consideration is that not all plastic surgeons participate with insurance companies. This is because the insurance companies often do not pay even close to what the surgeon would normally charge (they may pay only 5% or 10% of the normal fees). Also, the insurance companies often require an extensive amount of paperwork and prior authorizations which usually makes the whole process ridiculous. Talk to your surgeon and they should be able to help you or refer you to someone who can. Good luck with your surgery.
