I'm a mother of 4 children. 2 c-sections & twins. I am 5ft & weigh 100lbs. I used to have a great deal of core strength, but since having the twins 4 yrs ago, I seem to have no core strength no matter what I try. I have obvious space between muscles vertically. I saw a PS & voiced to him a main reason for me doing this surgery would be to regain muscle strength in the future. He told me this procedure is 100% cosmetic even though the muscles are stitched, it is purely visual purposes. True?
Abdominoplasty Cosmetic Purpose Only?
Doctor Answers (10)
Tummy tuck is a cosmetic surgery and is not an insurance-based surgery.
Thank you for your question.
Tummy tuck is a cosmetic surgery and is not an insurance-based surgery.
If you have a true hernia, insurance will usually cover the hernia but not a tummy tuck.
Cosmetic or coverable by insurance?
Hello, and thank you for your question! From my experience, as the other doctors have mentioned, the codes used to bill for an abdominoplasty procedure (15830, 15847) are considered cosmetic. My practice does not accept insurance, however, I have had patients that have requested surgical notes in hopes of submitting the claim to their insurance company on thier own and being reimbursed for some of their expenses. The diagnostic code 728.84 is the code for the separation of the abdominal muslce which may help you if you choose to go forward with trying to get reimbursed. Best of luck to you!
Tummy Tuck is generally considered cosmetic
As the differing answers suggests, the answer depends on the specifics of the case. If you need to have excess skin removed as well, then the procedure would be considered a tummy tuck procedure and most likely be deemed cosmetic. In certain circumstances, insurance will cover hernia repair. You will need significant documentation of a hernia including from your primary care physician or internist before most insurance companies would consider seriously your case.
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Rectus Diastasis Repair is Cosmetic
The repair of muscle is considered cosmetic if there is no hernia present. Based on your description this would be an abdominoplasty with muscle plication.
A tummy tuck is Cosmetic and insurance will not pay for it. Unless you have a hernia they will cover the hernia but the the abdominal plasty(tummy)
Muscle separation repair is part of cosmetic abdominoplasty
Insurance would cover a hernia repair, but because muscle separation (called a diastasis) is a common thing following pregnancy, repair of the diastasis is a routine part of a cosmetic tummy tuck procedure. Unfortunately the muscle separation is not something that can be improved with exercise, as you have experienced.
Ventral hernia may be covered by insurance
An abdominoplasty or tummy tuck by definition is a cosmetic procedure and would not be covered by insurance. If all that you need is tightening of your abdominal wall without any skin/soft-tissue removal then your insurance company will have to decide if they will cover this as a "ventral hernia". Whether they do so or not depends on various factors including your insurance company policy. Tightening of the abdominal wall can be performed via two small incisions, one near your pubic bone and the other by your belly button via an endoscope. This procedure is called an endoscopic tummy tuck. Of course this could just as easily and accurately be called an endoscopic ventral hernia repair.
All the best,
Dr Remus Repta
Twin Pregnancy with Rectus Muscle separation may be considered for insurance authorization for reconstructive repair
These are great questions. If a patient has a history of twin pregnancies and has a history of true complaints of abdominal/back weakness and discomfort based on a very large rectus muscle diastasis (separation vertically of the straight paired rectus muscles that straddle the belly button in the center of the abdomen), that may even produce a ventral (tummy side) hernia, then it is possible to submit to your insurance company a letter requesting authorization for the rectus muscle and/or ventral hernia repair. This is a part of the abdominoplasty procedure, the muscle repair. The remaining portion of the abdominoplasty procedure may be cosmetic. It is possible that if there is a large, hanging apron (pannus) causing discomfort, associated with skin ulceration/maceration, rashes and general hygiene problems, that this portion of the procedure may also be submitted for authorization. The American Society of Plastic Surgeons has Guideline Papers that assist plastic surgeons in submitting insurance codes for patient's diagnoses/symptoms and reconstructive procedures, so that insurance companies can review and consider these procedures for insurance reimbursement. Everything depends on your insurance policy. You can call your insurance company and be your own advocate since it is your policy and premium, assuming you are not in an HMO with restrictions and limitations. Twin pregnancies are often associated with the situation I described above and so a letter requesting authorization and photographs may be sent. You will still have to weigh the cost of the cosmetic portions of the procedure related to the surgeon's cosmetic fee, the operating room and anesthesiology fee. I have worked with patients on their behalf who have a true need for reconstruction of the abdominal wall related to twin pregnancies and my financial coordinators will put in writing what is cosmetic and have the patient sign that they know we are billing the insurance company for certain reconstructive portions of the procedure, and if the insurance company does not reimburse the procedure, they would know what they are responsible to pay. In this way, the patient knows ahead of time the total cost if the insurance company denies payment after the surgery is completed, which they reserve the right to do, even with a prior authorization. The insurance company holds the cards regarding payment so this is an additional risk, but if you know upfront what the cost will be in this worse case scenario, then this is acceptable. The worse situation is for the patient to have a great surgical outcome and be unhappy with the bill. I hope this helps you to understand that as plastic surgeons, when it comes to insurance, the insurance companies want to declare everything as cosmetic so that they will deny payment, even after a pre-authorization. We as good surgeons try to be advocates for reconstructive plastic surgery, but it is very difficult in today's insurance environment. Good Luck. Christine Petti, M.D., F.A.C.S.
Is My Abdominoplasty Cosmetic?
Some muscle separation is a normal result of pregnancy and therefore is not a covered procedure by an insurance carrier. Unless there is a true hernia or a very large and hanging pannus, insurance carriers will not cover an abdominoplasty.
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.