Will Insurance Cover Diastasis Recti if Causing Lumbar Spine Issues?

I have a very bad diastasis recti from pregnancy. I can press down with my whole fist and, in a mini-crunch, my ab walls will actually wrap around my fist. I have been told that insurance won't cover an abdominoplasty, so I resigned to trying to save $$$ for the procedure some time down the line. However, my lumbar spine is deteriorating (incl. herniated discs, spondylolisthesis, etc.) from severe hyperlordosis. The hyperlordosis is caused by the abdominal wall defect. Will insurance cover?

Doctor Answers (11)

Abdominoplasty is ALWAYS a cosmetic procedure

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Hi there-

Because there is no scientifically produced research to show that patients with back problems benefit from repair of diastasis recti, abdominoplasty surgery is not going to feb covered by your provider.

 


Orlando Plastic Surgeon
5.0 out of 5 stars 102 reviews

Diastasis recti

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We get many questions asking whether insurance will cover the cost of rectus diastasis repair, and for the most part, they do not .  However, every case is different.  It may be worth trying I your particular case, supporting your case with documentation from a spine surgeon.  I still think your chances are small, but you never know.  It's worth a try, but you will certainly need to be persistent about it. Good  luck!

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 11 reviews

It is best for you to check with you insurance company to see if repair of diastasis recti could possibly be a covered benefit.

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Thank you for your question.

It is best for you to check with you insurance company to see if this could possibly be a covered benefit.

Then, see two or more board-certified plastic surgeons in your area for a full and complete evaluation to make sure you are a good candidate and that it is safe for you to have surgery.  I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 37 reviews

Diastasis Recti and Insurance Coverage for Repair?

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I'm sorry to hear about the abdominal wall and back issues you are experiencing. Because every insurance companies'  policy is different, it will be best for you to check with your specific company in regards to coverage of diastasis recti repair.  Most likely, the insurance company will deem the  repair of the separation of the abdominal wall muscles  as “cosmetic” and not “medically necessary”.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 726 reviews

Insurance coverage and tummy tucks

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Unfortunately, insurance won't cover a tummy tuck.  But if you have a true abdominal hernia, insurance will cover this and part of the anesthesia and facility fees.

Jeffrey E. Schreiber, MD
Baltimore Plastic Surgeon
5.0 out of 5 stars 69 reviews

Rectus Diastasis Repair

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Insurance companies deem a rectus diastasis repair as not medically indicated - they call this cosmetic surgery.  It is very unlikely an insurance company will cover this.   

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.5 out of 5 stars 117 reviews

Insurance coverage for diastasis?

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It is hard to imagine how the back findings you describe could be related to a diastasis, or a hernia for that matter. 

However, you may not be able to distinguish a hernia from a diastasis, and in fact occasionally only a CT scan will make the definitive diagnosis. If you have a hernia, its repair would typically be a covered procedure. Having an evaluation, probably beginning with your primary physician would be in order.  Best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 31 reviews

Insurance may cover the rectus diastasis repairportion of the abdominoplasty.

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If a rectus diastasis is large enough it is considered to be a ventral hernia.   Your muscle that are usually parallel as in a six pack.  As we age, have kids, or gain and lose weight the muscles of the six pack can separate and if separated enough turn into a ventral hernia.  Obviously every tummy tuck is not covered but there are guidelines for coverage. Documented back problem and notation of ventral hernia must be made.   A small separation of a few inches will not be covered but we have seen 8 inches or larger separation occur.  Very large separations may even require a marlex mesh support.  In these situations there is real disability and insurance often considers this a covered entity.  The determination of a significant disability is necessary for coverage.   Photo documentation pre operative  can demonstrate a significant hernia as can intra operative  photo documentation.   Evaluation of the ventral hernia by the patients family docyor along with history may help.  Certainly coverage can be attained and is justified in selected cases.  My Best   Dr C

George Commons, MD
Palo Alto Plastic Surgeon
5.0 out of 5 stars 26 reviews

Diastasis Not Covered by Insurance

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-This is a very common question!

-Insurance will not cover the repair of rectus diastasis.

-During an abdominoplasty (tummy tuck), the rectus muscles will be brought back together in the midline.  However, this operation is considered to be cosmetic, and therefore insurance companies will not pay.

Joshua Cooper, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 14 reviews

Insurance does not cover diastasis

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I know that you are trying to make a case for the diastasis to be related to the lordosis and herniated discs but degenerative disc disease is not caused by diastasis. It is not considered functionally medically necessary and is cosmetic. You should address the spinal issues with an orthopedic surgeon. Best of luck.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 11 reviews

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.