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Referred to General Surgeon for Diastasis Repair Prior to Prolapse Repairs, Will This Include Tummy Tuck?

Aetna doesn't cover cosmetic surgery for diastasis recti alone. Will it cover because of GYN referral & DX's. Will the general surgeon do a tummy tuck or consult w/plastic surgeon as part of the diastasis repair? Wondering what a General surgeon can do & what insurance will cover. Have multi symptoms/issues; diastasis, pelvic pain, cystocele, rectocele & urethrocele. Did physical therapy & seeing chiropractor for muscle pain & nerve strain from core weakness. 3rd child 2 1/2 now, was 9lbs 10oz

Doctor Answers (7)

Complex abdominal will deformity

+2

Your problems are quite complex and it will require a plastic surgeon working with either a general surgeon or a GYN surgeon to determine how to proceed.  Your guess is as good as anyones if the insurance company will provide any coverage for the plastic surgical portion of the procedure.  Even though it is vital for a satisfactory result.  

Atlanta Plastic Surgeon
5.0 out of 5 stars 7 reviews

Insurance coverage for abdominal wall defects is variable.

+1

Most insurance companies will cover repair of hernias of the abdominal wall. Most insurance policies will not cover correction of diastasis. The specifics of your problem versus the provisions of your policy will determine if any reconstructive surgery of the abdomen is covered and under what circumstances.

Web reference: http://www.zubowicz.com/subpag,21-atlanta-abdominoplast.htm

Atlanta Plastic Surgeon
4.5 out of 5 stars 6 reviews

Diastasis

+1

there is no insurance that i am aware of that will cover a tummy tuck and diastasis repair. the general surgeons are usually not able to do this surgery

New York Plastic Surgeon
5.0 out of 5 stars 9 reviews

Insurance coverage for diastasis recti repair

+1

 Despite the multiple other problems you have, it is doubtful that your insurance carrier will allow any surgeon to tie them to the diastasis recti and claim that the repair of the diastasis is medically indicated, although treatment for the other conditions certainly would be.  There is not any support for this in the medical literature.  While the general surgeon may wish to attempt the diastasis repair, or even a full tummy tuck as a component of another procedure, it is very unlikely that he will obtain coverage for that part of the procedure, and he may well risk losing coverage for the entire thing if the insurance company perceives an attempt at deception in order to obtain coverage for what they deem to be a cosmetic procedure.

San Diego Plastic Surgeon
5.0 out of 5 stars 6 reviews

Referred to General Surgeon for Diastasis Repair Prior to Prolapse Repairs, Will This Include Tummy Tuck?

+1

These questions will have to be directed to your surgeons. Most general surgeons do not do diastasis repairs.

Chances are the carrier will not cover diastasis repair, since they hold these to not cause symptoms or health problems. 

See your consultants with these questions. All the best. 

Seattle Plastic Surgeon
4.5 out of 5 stars 28 reviews

Insurance coverage for a diastasis repair is unlikely

+1

Diastasis of the abdominal muscles does not produce pain and is not a true hernia. Since repair is not of 'medical necessity' insurance coverage is very unlikely, and even after an initial allowance the procedure might be denied payment on review. Just what a general surgeon will do is only our guess, and if you are interested in a tummy tuck you might best consult with a plastic surgeon in your medical plan.

Web reference: http://www.peterejohnsonmd.com/tummy-tuck

Chicago Plastic Surgeon
4.0 out of 5 stars 25 reviews

Insurance coverage for tummy tuck

+1

If you need a diastasis repair and tummy tuck, then go see a plastic surgeon.  Insurance companies never cover true tummy tucks.  They sometimes cover a "panniculectomy" which is just trimming off the overhanging skin and fat, but this does not include a diastasis repair.  If you try have your doctor try to sneak it past the insurance company with deceptive language, they will likely disallow the whole claim and your costs will be higher than if you had planned on the cosmetic procedure ahead of time and paid for it out-of-pocket.

Charlotte 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.

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