Why is Diastasis Recti Repair Not Covered by Insurance?

asked 2 years ago by 2724anon in Knoxville, TN
Latest answer by Armando Soto, MD
Question viewed 2,627 times
Tags: diastasis recti, insurance

If I ripped any other muscle in my body, it would be covered by insurance. Why is this not? It's not simply cosmetic. I have an extremely large gap, which is causing my intestines to press against what's left of my muscle membrane. I have GERD, lower back pain and digestive problems as a result. I understand cutting off excess skin is cosmetic, but this is tender and sometimes painful. If I had ripped my arm or leg muscles apart in an accident - that would be covered. And neither of those areas house important organs.

7 answers to Why is Diastasis Recti Repair Not Covered by Insurance?

Rectus Diastasis repair is always cosmetic

Hi there- The key distinction to understand in the analogy you make is that rectus diastasis, if left unrepaired, should not be expected to create a worsening disability over time. Therefore its repair is simply (and always) cosmetic in nature. I do also agree with Dr. Aldea- what is and what isn't covered by your particular plan has more to do with the contract you signed than with the details of your condition. Unfortunately, this is not a case where determination and... more

Armando Soto, MD
Orlando Plastic Surgeon

www.DrArmandoSoto.com

Diastasis recti repair not covered by insurance

Great question. Call your insurance company for their position. Have a PS write a letter of predetermination for you. OR just pay for the operation. From MIAMI DR. B

Darryl J. Blinski, MD
Miami Plastic Surgeon

Insurance "Coverage" of Separated Muscles

"If I had ripped my arm or leg muscles apart in an accident - that would be covered" GREAT question but - Answer - not what you want to hear. A health insurance policy is in fact a contract between the company and you or your employer. The type and amount of health care costs that will be covered by the health insurance company are specified in advance, in the member contract or "Evidence of Coverage" booklet. Each company, as an independent business, has... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

Diastasis recti repair is not covered by insurance because they do not want to spend the money

I think there are times when there would be some mechanical and or functional improvement by repairing the diastasis recti. It is a normal occurrence with pregnancy and abdominal wall stretch. The best thing you can do short of surgery is to strengthen and tone your abdominal muscles. I encourage you to discuss this with your insurance carrier and see if they have any provisions for the correction of the diastasis. Next time you change insurance carriers, try to... more

Marcus L. Peterson, MD
Saint George Plastic Surgeon

Insurance Coverage of Diastasis Repair

Diastasis recti is as has been previously pointed out a normal consequence of pregnancy. It would be unusual for a diastasis to cause pain or other symptoms. If you could convince your insurance company that you do have pain as a result of the diastasis, they might be willing to cover the repair. However, this is only a small part of the tummy tuck procedure and they definitely would not cover the remainder of the procedure.

John Whitt, MD
Louisville Plastic Surgeon

Diastasis recti

Diastasis recti is a separation of the recti abdominus muscles and is a normal, expected consequence of normal pregnancy. There is usually no functional disability unless a true hernia has also occurred or there is extreme diastasis.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Diastasis Repair and Insurance

The reason that insurance companies do not cover diastasis repair is that you have not torn any muscle in the process. A diastasis is a spreading of the linea alba, which is a very strong fibrous band that runs between your rectus mucles and goes from your sternum to your pubis bone. There is no muscle component to it, and usually has no medical conditions associated with it. After pregnancy, it is very common for the line alba to remain stretched out. There are... more

Christopher V. Pelletiere, MD
Barrington Plastic Surgeon

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