Will Tricare Cover Abdominal Muscle Plication?

After having my daughter, I realized I had diastasis recti. I have not been able to correct it with exercise and it is causing abdominal bulging and back pain though not severe. I was wondering if anyone knew or had an experience when tricare covered abdominal muscle plication. And if so, if that covered procedure could be done in conjunction with an elected procedure (breast augmentation). Thank you!

Doctor Answers (9)

Rectus Diastasis is not covered by Tricare

+2

After spending many years in the Air Force as a plastic surgeon and now practicing outside the military I can tell you that Tricare does not cover the repair of a rectus diastasis.  Keep working on muscle toning and core exercises and this should help your back.  A formal abdominoplasty should help with all of the issues you have described but this is considered cosmetic.

Best Wishes

Dr. Peterson


Saint George Plastic Surgeon
4.5 out of 5 stars 13 reviews

Tummy Tuck

+1

First call your insurance and see if that is a covered procedure.  Next, if they cover the procedure, only that part of the procedure is covered.  You will have to pay for the other part and split up the anesthesia part of the procedure.  We recommend wearing the garment part of the day to minimize the swelling.

Vivek Bansal, MD
Danville Plastic Surgeon
5.0 out of 5 stars 9 reviews

Tricare and diastasis recti

+1

Historically, insurers would consider payment for the portion of an abdominoplasty associated with the diastasis. However, they have all tightened criteria in the past few years and now reject diastasis as cosmetic in nature. Insurers are required to post their criteria for coverage online so I recommend that you review these. Tricare is generally restrictive and requires preauthorization for all procedures.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 9 reviews

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Tummy Tuck and Tricare

+1

It is highly unlikely that Tricare will cover repair of diastasis recti / tummy tuck. It doesn't hurt to ask, but don't get your hopes up. More than likely you are looking at an out of pocket expense for a TT and BAM.

Derek Lou, MD
Houston Plastic Surgeon
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Tricare and tummy tucks

+1

In my experience TRICARE will not cover abdominoplasties even in the case of moderate to severe diastasis rectii.

 

Delio Ortegon, MD
San Antonio Plastic Surgeon
4.0 out of 5 stars 13 reviews

Tricare Will Not Cover Tummy Tuck

+1

Tricare will not cover a tummy tuck nor a repair of a diastasis recti which is pretty much universial (to a greater or lesser extent) following pregnancy.  Your back pain may or may not be improved with a tummy tuck and muscle plication.  Even if it is, it is extremely unlikely that it would be covered by Tricare or any insurance carrier.

John Whitt, MD
Louisville Plastic Surgeon
5.0 out of 5 stars 2 reviews

Will Tricare Cover Abdominal Muscle Plication?

+1

Most likely it would not be a covered benefit but you can have a surgeon write a predetermination letter to  TRICARE. I believe you combining other cosmetic operations would also cause a denial. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 61 reviews

Tummytuck

+1

We have not been successful with Tricare. A tummytuck can be combined with a breast augmentation, but both are considered cosmetic surgery. Since the insurance companies set the criteria, doctors and patients have no control over them.

Michael Hueneke, MD
Nashville Plastic Surgeon
5.0 out of 5 stars 24 reviews

Recus Diasthasis is a cosmetic problem

+1

Separation of the the abdominal muscles - rectus diasthasis - is very common after pregnancies.  Unfortunately no amount of exercise will correct this becuase it is not a problem with muscle strength. The only way to correct this is to suture the muscles back together into the normal position. While I have no personal experience with Tricare insurance, insurance companies regard this problem as cosmetic in nature and will not cover it.  In order to be considered "medically necessary", you would need to prove that this is interfering with your abiltiy to perform activities of daily living.  In my experience, this is difficult (probably impossible) to demonstrate.

Matthew Schulman, MD
New York Plastic Surgeon
5.0 out of 5 stars 163 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.