Insurance Coverage for Muscle Repair from C-sections Damage?

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. 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!
Best wishes!

Unfortunately, insurance does not cover a tummy tuck. Occasionally with documentation of recurrent infection they will pay for a panniculectomy (simply removing loose skin).#tt#tummytuck

If you have an abdominal wall hernia, then insurance will cover this.  But what they wont cover is thightening of the abdominal wall and excision of the skin, i.e. abdominoplasty.  You need to see a general surgeon to see if you have a hernia that needs to be fixed.
Good luck.

If the muscle damage has resulted in hernias, then insurance should cover this surgery. If you're looking to tighten the muscles and remove some excess skin and fat, then insurance may deny this as being considered a tummy tuck. However, if you do have a hernia and want a cosmetic tummy tuck at the same time, the insurance coverage will help defray some anesthesia and facility fees. Be sure to check out some before and after photos if you do want a tummy tuck to see what results you can expect.

This is a difficult question to answer and it depeds on the provisions of your plan. Your best option is to obtain a consulation with a plastic surgeon or general surgeon and have them compose a predetermination of benefits to you insurance provider.

In my practice this is a very common question as it would
seem likely that restoring the body after pregnancy would be medically
necessary especially since pregnancy can cause diastasis of the abdominal
muscles.  A diastasis is a slight
separation of muscle that can cause abdominal laxity which can be furthered strained
after c-section procedures leaving some women with a “pouch” in the lower
abdomen.  The only way to improve the
diastasis and tighten the abdominal muscles is with an abdominoplasty.  Unfortunately, insurance companies do not cover
abdominoplasty procedures because they do not consider repairing a diastasis as
a reconstructive procedure regardless of what the cause of the muscle
separation may be.  To be considered a reconstructive procedure, a
procedure needs to restore functionality, correct a deformity, or repair a
defect like a hernia.  A hernia involves
a complete separation of muscle that allows the internal organs to protrude into
the abdomen.  For patients who have a history
of multiple failed hernia repairs, abdominal wall reconstruction can be done to
close the defect and reinforce the abdominal muscles.  However, abdominal wall reconstruction does
not tighten all of the abdominal muscles or remove large amounts of excess
tissue like a tummy tuck.  Typically
after pregnancy, women require a tummy tuck to restore their pre-pregnancy
bodies but without a physical examination it is difficult to provide an opinion
as to which procedure is best for you.  I
recommend scheduling a consultation with a board certified plastic surgeon to
receive a customized surgical plan to help you achieve your pre-pregnancy look.Be well and good luck!@norrisplastic

Thank you for the question and congratulations on your weight control.

It would be in your best interests to be examined by well experienced board-certified plastic surgeons who can then further guide you. Generally, it is becoming more and more difficult to obtain insurance coverage but if there is “muscle damage” or herniation is present,  then this may be possible.

Best wishes.

 

Insurance companies will provide coverage for repair of an abdominal wall hernia if one exists. More commonly, however, there is not hernia but a weakness in the abdominal wall called a rectus diastasis. While this may be distressing it posed not health concerns and is therefore not a deformity typically covered by you health insurance provider. As for performing a tummy tuck when an abdominal wall hernia is repaired, this is certainly feasible and often convenient. Its repair, however, does not require that a tummy tuck be performed so don't expect that they will authorize coverage of the tummy tuck. Most likely, you will need to pay out of pocket for the tummy tuck while costs for the repair of a hernia would be covered. If no hernia exists, don't expect your insurance carrier to provide any degree of coverage no matter how damaged the muscles are.

This smells a lot like a tummy tuck, and insurance will smell it too.  It of course depends on the medical necessity.  This would include hernia etc.  Insurance companies are very difficult.

Insurance will cover the muscle repair, but not the tummy tuck. The muscle can be repaired without the tummy tuck, so it is separate and considered cosmetic. And usually the insurance does not pay a lot toward the whole procedure. So look at it as a cosmtic procedure (you pay) with a litle help of the insurance company.