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!

Tags:

Comment on this

22 Doctor Answers | Asked by M'dea in Long Island, NY

Doctor Answers (22)
Community Comments (1)

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... more

Yes, it can be covered

Hernias are frequently discovered either during a consultation or even during the abdominoplasty surgery (asymptomatic). In both cases, repairs can be covered by the health insurance.

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.

Is tummy tuck covered by Insurance?

Insurance does not cover a tummy tuck but it does cover repair of umbilical or incisional hernias. If a tummy tuck is conducted at the time of umbilical hernia repair the cosmetic portion of the procedure is not covered by insurance.

Umbilica Hernia Repair is Frequently Considered Medically Necessary by Insurance Carriers

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... more

Tummy Tuck with Muscle and Hernia Repair Covered by Insurance?

Yes most health insurance plans cover a hernia repair. I have had many patients have a tummy tuck done and at the same time I repair the hernia. Good luck!

Repair of umbilical hernia with tummy tuck

Repair of umbilical hernia is a covered procedure although insurance companies are placing more demands on surgeons to establish proof of this condition prior to authorizing surgery. However the abdominoplasty will not be considered reconstructive and this service will not be covered. The NY hospitals, in general, are reluctant to permit hybrid cases because they raise issues as to different fees being charged to cosmetic patients v. insurance companies but some ambulatory surgery centers... more

Combined hernia and tummy tuck (abdominoplasty): payment considerations

There are two issues here: 1) should the hernia be repaired at the same time and 2) will insurance cover a portion of the procedure. If the hernia is a true umbilical hernia, repairing at the same time as a full tummy tuck may result in compromise of the circulation of the umbilicus. Furthermore, these defects are increasingly being repaired laparascopically or with the use of mesh. In some instances, hospitals do not grant these privileges to plastic surgeons and a general surgeon may... more

Otto Joseph Placik, MD

33 reviews

Chicago Plastic Surgeon

Insurance will probably cover an umbilical hernia when fixed at the time of a tummy tuck.

I encounter fascial defects (eg. umbilical hernia) with abdominoplasties all the time. Fixing them is part of the operation and I charge no more for doing it. If the patient wants reimbursement from the insurance company, I'm glad to provide the operative report substantiating the claim.

Having an Insurance-paid Umblical Hernia Repair at the same time as a Tummy Tuck

A lot of women have umbilical hernias and wish to have them repaired at the same time as a Full Tummy Tuck BUT have their insurer pay for the cost of the umbilical hernia repair. Problems - You are ASSUMING your insurer would gladly pay for your umbilical hernia repair. Your particular plan may not pay for it or require you to have it done by only certain surgeons who may not want to wait and work with your Plastic surgeon. It is unlikely that the insurer would want to pay the... more