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Is Rectus Diastasis Repair Ever Medically Necessary & Covered by Insurance?

I have rectus diastasis as well as 2 hernias from a twin pregnancy. I have visited 1 gen surgeon & 1 plastic surgeon. I have been told the hernias would be covered under my insurance but the rectus diastasis wouldn't. Is there anyway I can get it covered? I was also told that having the gen surgeon present repairing the hernias wouldn't cut costs(hospital fees, anestesia) on the other half of my surgery with the plastic surgeon ( "b/c he runs under a different clock")... Is that true?

Doctor Answers (7)

Diastasis repair and insurance

+1

Your situation is not uncommon.  Hernia is a covered insurance procedure, diastasis repair is not.  Both can be fixed at the time of abdominoplasty.  The insurance covers the hernia repair and an overnight stay, other than that the rest is out of pocket for the abdominoplasty.

Richmond Plastic Surgeon
5.0 out of 5 stars 13 reviews

Combining medicall necessary and cosmetic procedures

+1

can be tricky in most facilities.  You will need to explore this further with where you are planning to have your surgery.  In addition, the surgeon doing the muscle tightening is not going to be paid by the insurance company and in reality, he shouldn't. 

If you want to keep this 'clean' when considering billing and co-pays, you can have your hernias repaired first then come back at another time and have your cosmetic tummy work done.

In summary, diastasis is NOT covered by insurances and you should pay extra if having a cosmetic procedure done at the same time.  We have learned from our transgressions in the past.

Redding Plastic Surgeon
4.5 out of 5 stars 15 reviews

Insurance usually covers hernia repair but not diastasis recti. Both can be repaired during a tummy tuck.

+1

Thank you for your question.

Insurance usually covers hernia repair but not diastasis recti. Both can be repaired during a tummy tuck.

Check with your board-certified plastic surgeon to discuss specific details.

Best wishes.

Nashville Plastic Surgeon
5.0 out of 5 stars 21 reviews

Hernia with abdominoplasty

+1

I agree that rectus diastasis is not covered.  However we repair the hernia in addition to the rectus diastasis so it is possible to save a small amount of money since we perform both procedures. Good luck

West Orange Plastic Surgeon
4.5 out of 5 stars 22 reviews

Insurance does not cover diastasis rectus

+1
I agree. Insurance companies in NY stopped paying for repair of diastasis several years ago as part of their efforts not to pay claims. The hospital does start the clock again when the plastic surgeon comes in and, unfotunately, it becomes more expensive to combine the two procedures than to have them separately. Of course, the abdominoplasty part of an operation is cosmetic and not covered.
New York Plastic Surgeon
5.0 out of 5 stars 8 reviews

Diastasis recti repair is almost never covered by insurance.

+1

Hi.

This is a common situation.  The diastasis repair is cosmetic surgery and you will have to pay for that directly.

Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Insurance coverage of rectus diastisis

+1

Yes, that is true.  Your insurance company may cover your hernia repair but will not cover the rectus diastasis repair.  If you choose to have both procedures, then the hospital will set a clock and charge your insurance company for the OR and anesthesia time required for the hernia repair but not for any non-covered procedures you have at the same time.  There really is no way to game the system and it sounds like your plastic surgeon is being honest with you.

 

Good luck.

Web reference: http://www.ShaferPlasticSurgery.com

New York Plastic Surgeon
5.0 out of 5 stars 52 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.