What is the Best Way to Plead Tummy Tuck Case to Insurance?

I'm a mom of 2. After 2nd child I noticed that I had umbilical hernia. I got that repaired. In the Dr's summary he said "The abdominal wall was extremely thin around the hernia, and for this reason, the fascia was debrided in a longitudinal ellipse." 2 years later I start working out, abs especially, and another hernia has appeared! How disheartening! My Dr says that it's a hernia and gives a referral to a general surgeon. I don't want to get this repaired for it to only come back. Any Advice?

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15 Doctor Answers | Asked by ShayBe in Baltimore, MD

Doctor Answers (15)
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Insurance hernia repair

If there is a true hernia, then a repair would clearly be covered by your insurance company. A tummy tuck will not be covered by your insurance company.

Insurance coverage of a tummy tuck

A tummy tuck is a safe and effective procedure to contour the abdomen, create a tight waist, and remove extra skin, fat, and stretch marks. Many of our patients have this procedure done at the same time as another surgery such as a gynecological procedure or a hernia repair. If you have a pre-existing umbilical hernia, your best bet is to work with a plastic surgeon who is board-certified and has great deal of experience with abdominoplasty, liposuction, and body contouring. They... more

Tummy tuck and hernia repair

What is the Best Way to Plead Tummy Tuck Case to Insurance? I'm a mom of 2. After 2nd child I noticed that I had umbilical hernia. I got that repaired. In the Dr's summary he said "The abdominal wall was extremely thin around the hernia, and for this reason, the fascia was debrided in a longitudinal ellipse." 2 years later I start working out, abs especially, and another hernia has appeared! How disheartening! My Dr says that it's a hernia and gives a referral to... more

Tummy Tuck

You appear to have marked abdominal wall protuberance, related perhaps to abdominal wall weakness, but also to your weight. It will be difficult or impossible to improve by abdominal exercise, and I've had patients built like yourself with disabling back problems. My recommendation is to lose the weight first by seeking professional help, either a reputable weight loss center or, if indicated, by bariatric surgery. See your primary care physician to discuss. ... more

Tummy tuck and insurance

Unfortunately, tummy tucks are not covered by isnurance, but if you have a true hernia, that certainly would be.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Tummy tuck is elective cosmetic surgery

I agree with my colleagues in this case. A tummy tuck is an elective cosmetic procedure that women undergo to improve the appearance of their abdomen after having children. Hernias are covered by insurance and there are times that small umbilical hernias are fixed at the same time, and it is conceivable that the insurance would cover the general surgeon (or even possibly plastic surgeon) to repair this during a tummy tuck; however, the tummy tuck is not medically necessary... more

Hernias are covered by insurance, tummy tucks are not

Simply enough, you can have your hernia done and covered by insurance as medically necessary but removing the extra skin and tightening the rest of the muscles in a tummy tuck is not medically necessary (it is cosmetic) and is not covered by insurance. The two surgeries can be done at the same time but the tummy tuck portion is your responsibility to pay for.

Tummy tuck and insurance coverage

To be fair, getting insurance to cover a tummy tuck may not be appropriate. Your hernia repair should be covered by insurance as it is a medical condition.

Tummy tuck is a cosmetic operation

I am a bit wary when a patient seeks insurance coverage for procedures that generally are considered cosmetic, and so are insurance companies. Basically, if you have a hernia, then hernia surgery is medically indicated and is usually done by a general surgeon, although plastic surgeons often repair hernias as well. If you are seeking to COMBINE a medically indicated, insurance-reimbursed hernia repair with an abdominoplasty (tummy tuck), you may be able to avoid a second operation... more

Recurrent hernia formation of abdomen versus tummy tuck

You are more likely to get insurance coverage if you have this repaired as a hernia. Preventing recurrence may be related to several factors you should discuss with your hernia surgeon.