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Does Insurance Cover for Umbilical Hernia and Diastasis Recti? I Need a Full Tummy Tuck but Wanted to Do It at the Same Time.

I need a full tummy tuck for excess skin and stretch marks due to having 3 kids but I think this is due to separation of my weak muscles that also caused a hernia. I want to know if any Plastic surgeon in Houston who can correct this hernia at the same time doing a tummy tuck and having the insurance cover for the hernia, and operation room as well as anesthesia . I do not want to be operated twice and like to get 2 procedures done in one day for fast recovery, as well as save time and money.

Doctor Answers (8)

TT and hernia repair

+1

Although it does make sense to do these at the same time, your insurer will probably cover the hernia repair, and cover the OR and anesthesia for the time required to do that repair. The rest of the time billed for the operatory and the anesthesiologist as well as the plastic surgeon's fee would be your responsibility.

Although some plastic surgeons may be comfortable with hernia repair, I wouldn't exclude those who think it better to call in a general surgeon to fix the hernia. Pick the plastic surgeon who you feel is the one you want to do the TT. Let him or her help decide who is best to fix the hernia.

Best wishes.


Seattle Plastic Surgeon
4.5 out of 5 stars 34 reviews

Repair of Umbilical Hernia and Tummy Tuck at Same Time.

+1

Umbilical hernias are usually covered by insurance.  Tummy tucks are not.  We will often work with our General Surgeon colleagues to do the operation at the same time.  During the procedure we will address the diastasis recti.  The patient will be responsible for the cost of the Tummy Tuck and Diastasis Repair surgery, (i.e.; Plastic Surgeon Fee, Anesthesiologist Fee, OR/Hospital Fee etc;).  Best to ask your favorite General Surgeon and Plastic Surgeon who they work with.  Go see a few surgeons and see what can be worked out in your particular case.

Jeffrey Roth, MD
Las Vegas Plastic Surgeon
4.5 out of 5 stars 9 reviews

Umbilical Hernia and Diastasis Recti

+1

In Ontario, Canada umbilical hernia is an insured procedure.  Diastasis Recti is not insured as it is a standard part of an abdominoplasty which is a cosmetic (elective) procedure.
In most cases if a patient is having an abdominoplasty and requires repair for an umbilical hernia, both procedures would be booked at the same time.

Alexander Golger, MD
Toronto Plastic Surgeon
4.5 out of 5 stars 8 reviews

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Abdominal hernia

+1

If you have a true hernia, insurance should pay for that part but not the tummy tuck part.  If what you have is simply rectus diastasis, which is not a true hernia, it is unlikely insurance will cover it.  Insurance companies have become very leery of patients getting tummy tucks covered under the notion that they have a hernia. If you do have a real hernia, they should pay for PART of the surgery, not the whole thing.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 12 reviews

Sometimes

+1

Most of the time depending on the deductible it will cost more for the patient if you use the insurance while doing an umbilical hernia repair at the same time as a tummy tuck . I consider a repair of a diastasis recti to be an integral part of a females tummy tuck procedure.

Walter D. Gracia, MD
Arlington Plastic Surgeon
4.5 out of 5 stars 3 reviews

Insurance coverage for umbilical hernia

+1
Insurance may cover a documented umbilical hernia but, at this time, the NY insurers will not cover diastasis recti. Having the procedures simultaneously will save you recovery but probably not money. Insurance will not pay the anesthesia and OR fees for a 3 hour operation of which 15 minutes is reconstructive! The clock restarts and you will be billed, at the full rate charged to the insurance company, not the discounted cosmetic rate, for the tummy tuck. Honestly, insurance companies aren't stupid and they know full well that the larger goal of most patients is cosmetic and they do not want to facilitate or share the cost; the hospitals take the same position. You may find it less expensive to have the entire procedure performed as a cosmetic case in an ambulatory surgery center which offers a special rate to the plastic surgeon.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 13 reviews

Combining umbilical hernia repair and tummy tuck

+1

Umbilical hernias can usually be repaired at the same time that a tummy tuck is performed.  Your insurance carrier should cover the surgeon's fee for the hernia repair, as well as the operating room and anesthesia costs for the time used to perform the hernia repair.  You would be responsible for the additional surgeon's fees for the tummy tuck, as well as operating room and anesthesia charges for the time spent performing the tummy tuck.

Good luck.

Craig S. Rock, MD
Houston Plastic Surgeon
5.0 out of 5 stars 18 reviews

Umbilical Hernia and Tummy Tuck Done at Same Time?

+1

Thank you for the question.

Many plastic surgeons feel comfortable repairing umbilical hernias at the same time as the tummy tuck is being performed. 

Generally speaking, insurance companies may provide coverage for repair of umbilical hernia surgery. This coverage will apply to the operating room and anesthesia expenses for this portion of the operation. Otherwise, the remainder of the procedure will likely be out of pocket expense;  this will likely include expenses of operating room and anesthesia time that is not associated with the umbilical hernia repair.

I would suggest that you choose your plastic surgeon based on quality of work;  saving money should be secondary given that revisionary surgery may be costly in many ways.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 794 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.