Why Do Insurance Companies Not Cover Abdominal Diastatis Repair?

I have severe abdominal diastatis from my 2 pregnancies. This starts at my breast bone down below my belly button. Help me understand why insurance companies will not cover the surgery of abdominalplasty. I am 18 months post partum, work out religiously, and my stomach looks worse than right after birth. Not getting this done soon and properly will cause problems in my back, etc for not have the full strength of my core muscles.

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9 Doctor Answers | Asked by sfmom2

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Rectus diastasis

Most insurance companies do not consider a rectus diastasis to be e true hernia, and they are right. The will cover the cost of a true hernia repair. The reason they are so adamant has to do with the fact that many plastic surgeons have abused the system in the past to get insurance companies to pay for a cosmetic procedure. The insurance carriers have responded by not covering the procedure even in the most extreme cases. Frankly, I agree with the insurance... more

If a surgery is for appearance or for self-esteem, it is considered cosmetic by Medicare and insurance companies. That is why tu

If a surgery is for appearance or for self-esteem, it is considered cosmetic by Medicare and insurance companies. That is why tummy tuck is not covered. To use your words, "my stomach looks worse than right after birth." The insurance companies know that tummy tuck surgery is for appearance and they do not pay for it. To word it another way, if a women wants to get abdominal surgery just for the benefit of diastasis or hernia repair and not for... more

Insurance coverage for a tummy tuck

Most insurance companies consider a tummy tuck for diastasis repair to be cosmetic. More data needs to be shown to prove the benefits of a tummy tuck for this condition. see video

Diastasis is not covered by insurance.

Diastasis recti is not covered by insurance companies as they consider this a cosmetic problem. Unlike hernia, where intestines (bowels) can get stuck and cause medical problem, diastasis would not give functional/medical issue that can be proven scientifically.

Insurance company denial for diastasis repair

This is an excellent question. Insurance companies now have algorithms for denying lots of procedures and, personally, I think that there is a strong link between the number of patents seeking a procedure and the rigor with which the insurer seeks to deny payment. Diastasis is a consequence of pregnancy but that is not why it is being denied. The insurance companies use a standard of functional medical necessity and have supported studies which indicate that diastasis does not impair... more

Insurance coverage for rectus diastesis after pregnancy

Thank you for your question. Rectus diastesis is a normal consequence after pregnancy in most women. Since it does not cause a functional problem (no scientific study exists), insurance companies do not cover it. Disatesis is not considered a hernia, which is covered by insurance.

Why Do Insurance Companies Not Cover Abdominal Diastatis Repair?

Whether correct or not, the insurance companies consider this a cosmetic procedure as it affects appearance but hasn't been proven to affect function. (Frankly, there are severe cases where it may lead to back symptoms, but probably in the small minority of cases.) In a similar fashion, women who have their breasts irreversibly altered by pregnancy and nursing with severe deflation and stretching will not be covered by insurance for a breast lift or breast implants. more

Why Isn't A Rectus Diastasis Repaired Covered?

The development of a rectus diastasis is a normal consequence of pregnancy for many women. It is not a hernia nor a full rip or tear through the abdominal wall and does not cause a functional weakness to the abdomen. There is no study that shows its repair is going to improve the patient's function other than from a cosmetic point. Insurance companies will cover procedures that are medically necessary for either life-threatening or problems that impair the ability to... more

Why Do Insurance Companies Not Cover Abdominal Diastatis Repair?

The insurance carriers do not consider repair of diastasis to be medically necessary. The reason is that it has no scientifically acceptable evidence that this causes symptoms and that the treatment resolves those symptoms. The procedure is considered cosmetic, and I think most surgeons would agree with that. Thanks for the question and best wishes.