Tummy Tuck with Muscle and Hernia Repair Covered by Insurance?
- Asked by M'dea in Long Island, NY
- 4 years ago
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!
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.
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
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.
Umbilical hernia and tummy tuck surgery
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.
Tummy tuck and hernia repair
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.
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 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.
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!
Web reference: http://www.mahjouricosmeticsurgery.com
Repair of umbilical hernia with tummy tuck
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 be the one who performs the repair and the one who bills for reimbrusement. In regards to reimbursement, most facilities have separate fees and will bill for these individually with pre-payment for the cosmetic portion
Web reference: http://www.bodysculptor.com/body-surgery-chicago/tummy-tuck/
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.
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.