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Tummy Tuck with Muscle and Hernia Repair Covered by Insurance?

I need an umbilical hernia and abdominal muscle repair, and I would like to get a tummy tuck at the same time. I am pretty sure that my health insurance will cover the hernia repair. Is it possible for me to just pay the additional costs out of pocket for the tummy tuck portion of the surgery? Is this feasable? Would most surgeons agree to this? Thanks in advance for your insight!

Doctor Answers 34

Insurance coverage becoming more difficult to obtain for supposedly "covered" features

Health insurance companies are in business to take your premiums and hold onto your money as long as possible. Of course, many factors come into play whether your particular company will cover the medical problems that you mentioned. Much of it has to do with YOUR personal policy with the insurance company. It is becoming increasingly more difficult to have "covered" features in your policy covered!

To avoid problems, begin with a consultation with a board certified plastic surgeon who is experienced in body contouring, particularly tummy tucks. After a thorough evaluation and physical examination by the plastic surgeon documenting your medical issues, have his/her office contact the insurance company and obtain in writing what the insurance company's position is. Do not be surprised if additional evaluation/treatment(s) by other specialties are required. Hopefully, your insurance company will prorate the medical treatments related to the hernia repairs from the cosmetic portion.

My very best wishes for a happy outcome.

Englewood Plastic Surgeon

75 S. Madison St.
Denver, CO 80209

Hernia repair with tummy tuck

Thank you for your question.  Repair of a small, uncomplicated umbilical hernia is very commonly performed by the plastic surgeon as a part of the tummy tuck operation.  Insurance will usually cover the hernia repair; the tummy tuck (with associated OR and anesthesia time) is paid for out of pocket.  In the event that insurance approval for the hernia cannot be obtained, many plastic surgeons will perform this either free of charge or at a small additional fee.

Joshua D. Zuckerman, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 13 reviews

1111 Park Avenue
New York, NY 10128

A tummy tuck is considered cosmetic and elective

It’s not unusual to perform a tummy tuck at the same time as a hernia and abdominal muscle repair. However, as you noted, the tummy tuck portion of the surgery isn’t likely to be covered by insurance, and you’ll need to pay out of pocket for that. I would start by checking with your insurance company to see if they have any recommendations for how to proceed. It’s possible you will need two completely different surgeons who have to be willing to coordinate on this issue with you. I do recommend looking for a board certified plastic surgeon for your tummy tuck rather than having a general surgeon perform both aspects of your surgery.

Frank Campanile, MD
Denver Plastic Surgeon
5.0 out of 5 stars 25 reviews

425 S. Cherry St.
Denver, CO 80246

Your payment compromise should work fine

Combining hernia and muscle repair with a tummy tuck isn’t actually all that unusual. You’re correct in thinking that most insurance providers are likely to cover the cost of your hernia repair, but not the tummy tuck portion of the surgery. As long as you discuss paying for the additional costs out-of-pocket with your surgeon prior to your procedure, your insurance provider shouldn’t have a problem with both surgeries being performed at the same time. Of course, you should contact your plan administrator first to verify.

Nirav Savalia, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 31 reviews

180 Newport Center Dr.
Newport Beach, CA 92660

Yes, tummy tuck can be done at same time as hernia repair

Dear Donna,

It is quite common to have a tummy tuck at the same time as a hernia repair.

You will need to find a general surgeon and plastic surgeon who are willing to work together.

The insurance would cover the hernia repair and you would pay an extra fee for the tummy tuck

Ask your doctor who plans to do the hernia to rtefer you to a board certified plastic surgeon who can do the hernia repair.

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
5.0 out of 5 stars 65 reviews

195 Commonwealth Avenue
Boston, MA 02116

Tummy Tuck with Muscle and Hernia Repair in Melbourne, Florida

It has become increasingly difficult to predict what insurance companies will do regarding coverage for many procedures. While they are supposed to cover hernia repairs, they definitely will not cover any cosmetic surgery including a tummy tuck, and therefore, that part would be an out-of-pocket expense. If your insurance company is not being completely forthright or cooperative, you may be able to negotiate a prepay fee for the hernia repair with your surgeon. I would recommend discussing this at length with your board-certified plastic surgeon.

Amy Ortega, MD
Melbourne Plastic Surgeon
5.0 out of 5 stars 12 reviews

707 W Eau Gallie Blvd
Melbourne, FL 32935

Possible, but ask provider

This is possible but you will have to talk to your insurance provider and surgeon to find out the details of payment. 

Michael Constantin Gartner, DO
Paramus Plastic Surgeon
4.5 out of 5 stars 88 reviews

3 Winslow Place
Paramus, NJ 07652

Tummy tuck with muscle and hernia repair covered by insurance?

Hello! Thank you for your question! Surgical procedures for aesthetic purposes, to improve appearance, are not covered by insurance. Typically, these as well as complications resulting from such procedures are the responsibility of the patient. Procedures that are meant to correct functional issues and those which cause health-related issues should be covered by your insurance as a medical necessity, with proper examination and documentation. Some insurance plans have exclusion criteria for certain procedures. Also, it is an obligation of the surgeon not to attempt to authorize purely cosmetic procedures through insurance.  This is an excellent time to combine these procedures.  The facility and anesthesia time should begin upon completion of your hernia repair.

Discuss your issues and complaints with a board-certified plastic surgeon to discuss these as well as to examine and assist you in deciding which procedure(s) will be the best for you. A discussion of the advantages and disadvantages will take place along with the risks and benefits. Insurance companies will vary on coverage and is always reasonable to discuss your issues with your surgeon and primary care. It would behoove you to get as much information as possible and even call your insurance yourself. Certainly, pay in advance prior to your surgical procedure and options such as financing are available if you qualify. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 14 reviews

8900 E. Raintree Dr.
Scottsdale, AZ 85260

Insurance and Cosmetic procedures

Tummy tucks are considered cosmetic and removes the excess skin as well as repairs the muscle stretch after pregnancy.  Hernias are abdominal wall defects where the lining and contents can "herniates" through the defect. We sometimes widely elevate the skin around a hernia defect to adequately repair it, similar to the first half of a tummy tuck (where the muscles are pulled together in the mid line).  The question is whether your hernia falls on that line, if it is a true hernia (or a diastasis) and how much additional time after the hernia repair that it takes to do the diastasis and skin excision.  Some doctors offer discounts for the additional time after the hernia repair that is cosmetic and is often discounted for the less work involved as well as less anesthesia and facility time after the insurance portion of the procedure is completed.  Beware that some insurance companies will deny your claim if they see another cosmetic procedure was done at the same time.

Christopher J. Kovanda, MD
Minneapolis Plastic Surgeon
5.0 out of 5 stars 28 reviews

6545 France Avenue South
Edina, MN 55435

Tummy Tuck with Muscle and Hernia Repair Covered by Insurance?

Thank you for the question. Yes, umbilical hernias  can (and should) be repaired at the same time as tummy tuck surgery. Much will depend on the “comfort level” of your plastic surgeon;  in my practice, I repair hernias routinely during tummy tuck surgery. Some plastic surgeons prefer to  ask for the services of a general surgeon.  Sometimes,  hernia repairs are covered by insurance companies; you will need to check with your specific insurance company. Your plastic surgeon's office may be able to assist you with this inquiry. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,051 reviews

8851 Center Drive
San Diego, CA 91942

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.