Will Tricare Cover Abdominal Muscle Plication?

asked 1 year ago by addie's mommy in South Carolina
Latest answer by Vivek Bansal, MD
Question viewed 602 times
Tags: female, after pregnancy, diastasis recti, insurance

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!

9 answers to Will Tricare Cover Abdominal Muscle Plication?

Rectus Diastasis is not covered by Tricare

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

Marcus L. Peterson, MD
Saint George Plastic Surgeon

Tummy Tuck

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

Tricare and diastasis recti

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

Tummy Tuck and Tricare

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

Tricare and tummy tucks

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

www.sacs-sa.com

Tricare Will Not Cover Tummy Tuck

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

Will Tricare Cover Abdominal Muscle Plication?

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

Tummytuck

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

Recus Diasthasis is a cosmetic problem

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... more