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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 (29)

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

+3

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.


Boston Plastic Surgeon
5.0 out of 5 stars 37 reviews

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

+2

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.

Stephen A. Goldstein, MD
Englewood Plastic Surgeon

Possible, but ask provider

+1
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 55 reviews

Tummy tuck with muscle and hernia repair covered by insurance?

+1
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 12 reviews

Insurance and Cosmetic procedures

+1
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.

Tummy Tuck with Muscle and Hernia Repair Covered by Insurance?

+1
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 794 reviews

Hernia Repair Is Frequently Covered By Insurance

+1
If a patient presents with an abdominal wall hernia causing significant symptoms then insurance may cover the hernia repair.Usually, the surgeon responsible for the hernia repair needs to document the medical necessity for this procedure and obtain preauthorization from the insurance company.If the hernia is in the central portion of the abdomen, it is ideal to approach it through a tummy tuck incision.If the hernia is approached directly by making an incision directly over it, then a long incision in the central portion of the abdomen would result.This would be less cosmetically desirable than a standard low hip to hip tummy tuck type incision.If the skin and fat are not separated from the muscle layer, then it often bunches up in the midline when the hernia is brought together.This is another reason to perform this procedure through a standard tummy tuck approach.With the tummy tuck approach, a long horizontal incision is made from one hip to the other.It can usually be made low enough to be concealed in a standard two-piece bathing suit.The skin and fat layer is elevated off of the underlying muscle layer up to the belly button.When the belly button is reached, an incision is made around the belly button, freeing it up from the skin and fat layer.The skin and fat layer is then lifted off of the muscle layer up to the rib cage.At this point, the entire hernia normally is very well exposed and is ready for repair.After the hernia is repaired, the skin and fat layer is pulled snugly downward and the excess skin and fat are removed.The belly button is then brought out through a new incision and all of the wounds are closed.This approach allows for good visualization of the hernia and redistribution of the skin and fat over the newly contoured muscle layer.It is best if your surgeon explains this rationale to the insurance company in the preauthorization letter.Each insurance company looks at these types of procedures differently.

John J. Edney, MD
Omaha Plastic Surgeon
4.5 out of 5 stars 58 reviews

Umbilical hernia and tummy tuck surgery

+1

Yes, typically most insurance plans will cover the umbilical hernia repair while you will pay out of pocket for the cosmetic tummy tuck portion of the procedure. This is very common and you should consult with a board certified plastic surgeon for more detailed information depending on your specific health care coverage.

Best wishes,

Dr.Bruno

William Bruno, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 152 reviews

Tummy tuck and hernia repair

+1

Thanks for the question - it is definitely possible for your plastic surgeon to do both procedures at the same time.  You would simply pay for the extra anesthesia time, the extra OR time, and the surgeon's time while performing the tummy tuck as opposed to fixing the hernia.  Best of luck.

Christopher J. Davidson, MD, FACS
Wellesley Plastic Surgeon
4.5 out of 5 stars 17 reviews

Umbilica Hernia Repair is Frequently Considered Medically Necessary by Insurance Carriers

+1

Umbilical hernias are frequently seen in women with redundant abdominal tissue who request abdominoplasty surgery. When this situation arises, several important issues need to be resolved regarding insurance reimbursement. Umbilical hernia repair is frequently considered medically necessary by insurance companies and is therefore a covered expense. In contrast, abdominoplasty is very a rarely a covered expense.

Under these circumstances, your plastic surgeon should send a prior authorization letter to your insurance carrier. It typically takes about six weeks to get a response. If the procedure is approved by the insurance company, several important issues will still need to be resolved. At this point, it’s appropriate to get a cosmetic fee quote for the tummy tuck portion of the procedure since this will not be covered by insurance.

In some cases, it may not be medically advisable to perform the hernia repair in combination with abdominoplasty because of the potential to impair the blood supply to the umbilical stalk. In other cases, logistical issues may make it difficult to proceed as well.

Insurance carriers often stipulate where and who will perform the hernia repair. Unfortunately, this can significantly impact the overall expense and convenience of the abdominoplasty. In some cases, they may require inpatient surgery in a specific facility, which may significantly add to the expense of abdominoplasty. These issues can be very complicated. For these reasons, it’s important that you thoroughly discuss them with your plastic surgeon before proceeding.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 90 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.