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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, 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.

Gregory Turowski, MD, PhD

Chicago Plastic Surgeon

ASPS

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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Brooke R. Seckel, MD

Boston Plastic Surgeon

ASAPS ASPS

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

Robert L. Kraft, MD

New York Plastic Surgeon

ASPS

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

Chicago Plastic Surgeon

ASAPS ASPS

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.

Vincent N. Zubowicz, MD

Atlanta Plastic Surgeon

ASAPS ASPS

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

Peter A. Aldea, MD

Memphis Plastic Surgeon

ASPS

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... more

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B. Pat Pazmino, MD

Miami Plastic Surgeon

ASAPS ASPS

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

Stephen A. Goldstein, MD

Denver Plastic Surgeon

ASAPS ASPS

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.

Robert M. Freund, MD

New York Plastic Surgeon

ASPS

Yes

The hernia should definitely be covered by your insurance. The Tummy Tuck can be done safely at the same time. The two procedures are nice to combine because it means only one recovery for you. You might even save a little money on the cost of the inpatient stay, if one is needed. Good luck

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Daniel Sherick, MD

Ann Arbor Plastic Surgeon

ASAPS ASPS

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.

Sanjay Grover MD

Orange County Plastic Surgeon

ASAPS ASPS

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... more

Kenneth R. Francis, MD

Manhattan Plastic Surgeon

ASAPS ASPS

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... more

William B. Rosenblatt, MD

New York Plastic Surgeon

ASAPS ASPS

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... more

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David Shafer, MD

New York Plastic Surgeon

ASPS

This is very feasable

There is no reason not to do the two procedures together and many plastic surgeons and general surgeons will work as a team to get this done. There may or may not be some savings. You and your doctors will need to work this out with the insurance co.

Robert D. Goldstein, MD

Bronx Plastic Surgeon

ASAPS ASPS

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!

Hisham Seify, MD, PhD

Los Angeles Plastic Surgeon

ASPS

I do the hernia repair for free

The repair of an umbilical hernia during a tummy tuck is such a tiny 5 minute procedure that I do it for free. Even if you tried to get insurance involved in this I would guess it would only cover a very small part of the total cost.

Richard P. Rand, MD, FACS

Seattle Plastic Surgeon

ASAPS ASPS

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.

Scott E. Kasden, MD

Dallas Plastic Surgeon

ASAPS ASPS

Tummy tuck and hernia

The hernia should be covered by insurance. The tummy tuck portion will not be covered. You will most likely have to pay for the extra OR time and anesthesia as welll as your surgeon's fee for the tummy tuck.