10 Cm Diastasis Rectus - Would That Be Considered a Medical Case with Insurance?

In my experience, insurance companies never cover the repair of rectus diastasis.

 Therefore, unfortunately, I think trying to get your insurance company to pay retroactively is likely a waste of your time.

Thanks for your question. Although 10cm is wide, it doesn't usually affect the function of your abdominal wall. Therefore the insurance company doesn't cover this type of surgery in my experience.

Diastasis recti is a midline separation between the rectus abdominis muscles.  It is a common and normal condition in newborns.  They usually grow out of it as the muscle grows.

Women typically develop it due to multiple pregnancies.  Women 12 or more weeks pregnant should avoid aggressive abdominal exercises, which can worsen the condition.

Insurance typically does not cover diastasis recti unless it is associated with symptomatic ventral or umbilical hernias.

If you paid for an abdominoplasty as a cosmetic procedure then there is no insurance claim to be made. If your surgeon told you he or she would file part of the surgery to your insurance company then it would typically be pre approved before the operation. As far as I know no insurance covers rectus diastasis repair. I hope this helps.

you clearly have the option to pursue cigna. they do not consider a diastasis recti to be medical y necessary and do not pay for the procedure

Unfortunately it is not an insurance case. Hernia surgery can be an insurance case. What you describe is usually from women having children an the two rectus muscles are stretched so much that the attachments that usually hold them together have pulled apart. We commonly sew them back together when we perform tummy tuck surgery. Your surgeon does not sound like he/she did anything wrong. The distance of the diastasis does not make it a case that is covered or not. It is cosmetic. 

Under most insurance plans, rectus diastasis is not a covered procedure for medical necessity.  Hernia is covered for hernia repair, but no aspect of the abdominoplasty is covered by insurance unless other criteria are met.

At this point (given that the procedure has already been performed),  I think that you will be wasting your time/efforts in pursuing insurance reimbursement. Chances are remote, if any, that an insurance company will consider correction of a diastasis recti ( no matter what the measurements) a medically necessary procedure.

 Best wishes.

When it doesn't affect your function or quality of life, it is usually considered cosmetic.  A protruding tummy does not affect your function and diastasis is subsequently not covered as a benefit.

Thank you for your question. Unfortunately insurance companies have their own criteria for what consitutes medical necessity. In some situations it can be quiete arbitrary.  Contact your insurance company and ask for the medical and documenation cirteria for rectus diastasis repair to be considered a medical necessity.  Get copies of your records and the ICD 9 and CPT codes from your doctor and submit them to your insurance company. Insurance companies tend to be more responsive to their members. Best wishes.