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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!
Asked 37 months ago by
M'dea in Long Island, NY
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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.
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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...
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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...
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Insurance will probably cover an umbilical hernia when fixed at the time of a tummy tuck.
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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...
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Insurance coverage for a tummy tuck and hernia repair
Tummy tucks are a very popular and effective way to contour the abdomen. It is possible to perform this surgery in conjunction with other surgeries such as gynecologic procedures or hernia repairs. If you have a small hernia or a separation of your abdominal muscles, your plastic surgeon may feel comfortable in repairing this by himself or herself. However, it is a significant hernia or one that requires a mesh repair, they may recommend to perform this procedure in conjunction with a...
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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...
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Medical costs are covered for medical issues
Although many insurance companies would have you believe that medical problems treated at the same time as a cosmetic procedure, this is more an attempt to not pay for your medical problem. At the least, they should pay for the medical treatments for the hernias, as well as the hospitalization and anesthesia bills. The last two bills may be prorated so as the pay only for that part of the procedure that is medical realted.
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Yes, umbilical hernia repair and abdominoplasty at the same time is possible
Yes. It is possible to undergo an umbilical hernia repair and abdominoplasty at the same time. Most insurance plans will cover the umbilical hernia repair; however, they will not cover the abdominoplasty. You should check with your plastic surgeon to see if they accept insurance payments or will assist you in billing your insurance.
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Yes, yes, and yes
Donna B,
In a word or three, yes. Many surgeons, myself included, would be very accommodating to this type of request. Your biggest out of pocket concerns might be anesthesia and hospital fees if your surgery is performed in a hospital operating room. You can save a significant amount of money by having your surgery in an office operating room with a plastic surgeon that can perform both procedures. Some insurance carriers will cover anesthesia and operating room fees in this setting...
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Depends on how good your insurance is.
An umbilical hernia repair is a relatively simple procedure usually performed by a general surgeon and only involves a small incision around your umbilicus. This may be covered by your insurance but is a much smaller procedure than a tummy tuck. A full tummy tuck involves a larger incision in your lower abdomen, raising the skin and fat off of the abdominal muscles. The rectus abdominous muscles which usually have spread apart from pregnancy are then sutured together. This gets rid of the...
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Yes, it is possible
In most cases the insurance will cover the hernia repair for the surgery. However, they will not cover the abdominoplasty surgeon fee or the operating room or anesthesia fees for the abdominoplasty. Patients often think that, "since I am in the operating room anyway, I will just get another procedure done." This is possible, but the insurance companies are no fools. They will cover the medically indicated part only.
The other consideration is that not all plastic surgeons...
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It is very difficult to get insurance coverage when tummy tuck is involved
In my practice, I just offer the hernia repair as part of the tummy tuck operation. It is very difficult to get approval for just the hernia repair. Once there is a cosmetic component, the insurance company will tend to deny it. The only saving any way will be the portion of the anasthesia and surgery center fees related to the hernia repair. This is minimal any way.
Good luck!
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Yes, umbilical hernias are typically covered
I find that umbilical hernias are common, and covered by insurance. The tummy tuck is cosmetic and therefore, not covered. I will either do the umbilical hernia or have a general surgeon do the hernia repair. This is a great time to do the abdominoplasty, and you and your plastic surgeon should be able to work out something.