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.
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.
A tummy tuck is considered cosmetic and elective
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 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
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.
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.
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!
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.
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.
Hernia Repair Is Frequently Covered By Insurance
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.