In my experience the insurance tends to pay for the professional component to repair an umbilical hernia at the time of an abdominoplasty. In our area, the facilityand anesthesia charges are more for the cosmetic component of the case than the cost to completely have the procedure in my in state licensed office surgery suite. As others have stated, the reimbursement is so poor, it really does not defray the cost of the tummy tuck surgery. Unfortunately, an umbilical hernia is not a reason to need a tummy tuck.
In general, I repair the hernia at the same time without a charge to you. The amount you usually have to pay for the deductible and the poor reimbursement do not make it worth the hassle.
Kenneth Hughes, MD
Los Angeles, CA
A majority of the patients I see for abdominoplasty have umbilical hernias. In fact most women who have been pregnant have this hernia. An umbilical hernia is just an opening or hole in the fascia (tissue that surrounds the abdominal muscles) within the belly button. Sometimes the opening results in fat from inside the abdomen pushing into the belly button. Most of the time this hernia is benign and doesn't cause a problem. Other times the opening can get small and the fat gets pinched resulting in "strangulated" fat. This is very painful.
When performing a standard abdominoplasty great care must be taken when repairing the hernia as there is already compromised blood supply. However, when an umbilical float tummy tuck is done, repair of the hernia is quite easy.
It is possible for some insurances to cover repair of the hernia. Usually we will start the tummy tuck as "repair of the hernia." Therefore the OR clock is ticking for the insurance time. Once the flap is lifted off of the abdomen and the hernia is repaired the "insurance" time is done and the "cosmetic" time starts. So repair of the hernia can defer some of the costs such as OR and anesthesia.
Yes, having an umbilical hernia usually helps with the anesthesia and facility fees when a tummy tuck is done at the same time. However, since every insurance company and even plan within the same company can vary we would need to verify coverage of this particular procedure. However, I frequently perform umbilical hernia repairs with a tummy tuck and patients love their results are thankful for the money that they saved. Thanks for your question!
Baltimore plastic surgeon
Thank you for your question. It is very common to combine an umbilical hernia repair with a tummy tuck and there are several advantages in doing so. The recovery is the same and you can have plication of the rectus muscles at the same time as your hernia repair which may improve your chances of the hernia never returning. If the hernia repair is covered by insurance you may find that the anesthesia bill with a combined cosmetic/ insurance case is less than if you had abdominoplasty alone. Good luck!
Hernia in a tummy tuck can be done together. I prefer not to do those together. Insurance would cover the hernia during a simultaneous tummy tuck but it would not cover the tummy tuck cost for the procedure and or facility and anesthesia time.
If you have an umbilical hernia which is causing a medical issue that needs to be corrected, your insurance provider will very likely cover the procedure. The procedure that will be covered, however, will be the repair of an umbilical hernia. They will not cover the costs of removing any additional skin, tightening the rectus muscle above or below the hernia, or translocating the belly button.
If you are wanting to have a tummy tuck surgery to improve the appearance of your abdomen, you should do so. During the procedure, if you have an umbilical hernia, the hernia can be repaired. Your surgeon could attempt to obtain some payment for the umbilical hernia repair from your insurance company, but unless the hernia takes significant time to repair or is extremely involved, they probably shouldn't. And if insurance didn't cover the procedure, they really shouldn't charge you anything either. Most umbilical hernias are completely corrected with the routine rectus plication step of an abdominoplasty procedure. Billing extra for the repair to either you or an insurance provider is not really warranted and slightly unethical.
Most insurance companies will cover the umbilical hernia but they are very specific. If you are having a cosmetic procedure at the same time they will want documentation as to when the cosmetic part starts. They will not pay for the surgeon, anesthesia and facility fee for the cosmetic part. The good news is that you recover from the two procedures the same way and at the same time.
Fascial defects such as an umbilical hernia are commonly encountered at the time of an abdominoplasty. Insurance generally will cover these but almost never cover the abdominoplasty.