I Want an Abdominoplasty. What Can Insurance do For the Hernia Repair I Need? (photo)

There's a a huge gap in my stomach muscles & hernia from pregnancy, I look pregnant. My chiropractor attributes it to core weakness. My stomach gets upset when I run- nothing feels tucked in. My hernia is painful with exercise.Had a consultation w/a PS, and he said most PS’s won't deal with insurance companies, but he’d fix my hernia along with the TT without charging extra.Are there surgeons out there who work with insurance companies? Thoughts on going through a residency program to save $?

Doctor Answers 5

Bulge after pregnancy: diastasis or hernia?

How can you tell the difference between a rectus diastasis - or weak gap between the vertical stomach muscles - or a true hernia? First of all, put your fingers in your belly button, while you are lying down. Do you feel an "edge" or "hole" that your fingers can drop through? Note: if yes your fingers are right next to your bowels right now! Next, lie down. When you try to sit up (like four or five inches), can you feel a gap between your muscle edges (esp check below the belly button)?

If you feel an actual hole, then you have a hernia. If you have the gap only, then you have a diastasis. Diastasis is never covered by insurance (believe me we have tried!) no matter how bad, at least here in los angeles. The hernia, however, is covered. The hernia repair will include a rectus diastasis repair, but not the extra skin removal. I bet with your impressive belly you at least have an umbilical hernia! Most surgeons are out of network but agree to bill on your behalf and reimburse you.

Beverly Hills Plastic Surgeon
4.7 out of 5 stars 13 reviews

Abdominoplasty with mesh reinforcement ventral herniorrhaphy

Insurance will pay for hernia repair which can be performed at the time of abdominoplasty.  The insurance company WILL NOT pay for the abdominoplasty portion of your operation.  Most plastic surgeons are trained in general surgery and can do both procedures to minimize your out of pocket costs.  Abdominoplasty with mesh reinforcement has been shown to be effective in producing weight loss and maintaining the reduced weight.

Best of Luck,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 223 reviews

Yes, hernia surgery and tummy tuck can be performed at the same time

Thank you for your question and photo. This photo does not look natural. Please see two or more board-certified plastic surgeons in person for a consultation and examination.  If you do have a hernia, hernias are usually a covered benefit under insurance. Tummy tuck is a cosmetic surgery.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 182 reviews

Repair of Hernia During Tummy Tuck

Based on your picture you certainly do look pregnant. I suspect that you have a very incompetent abdominal wall with Diastasis Recti ( separation of your large abdominal muscles) and likely a ventral hernia. This will require more than just a standard tummy tuck and may involve the need for synthetic mesh of biological grafts ( alloplastic material ). I strongly urge you to consult with a Board Certified Plastic Surgeon who performs reconstructive surgery. Many plastic surgeons who do reconstructive procedures take insurance. You can obtain referrals from the American Society of Plastic Surgeons. Good luck!

William H. Gorman, MD
Austin Plastic Surgeon
4.1 out of 5 stars 20 reviews

Rectus Diastasis

The separation you are describing is probably a condition called Rectus Diastasis.  This happens when the 6-pack muscles separate with pregnancy and fail to return to normal.  It’s not really a hernia.  My experience has been that no insurance companies will cover this.  I occasionally submit for persons with dramatic photos like you but again denial is the norm.  Sometimes depending on your insurance plan it’s actually less expensive to just have a cosmetic tummy tuck that will fix everything.  When you look at deductible and hospital costs for insurance surgery most of my patients really only end up saving a few hundred dollars not thousands if they save anything.  Resident clinics can be good option and cost less but you get what you pay for sometimes.  Surgery in general is very personal and I would go see a few other surgeons and maybe a resident and see what you think about each one.  Best of Luck. Dr. Kerr

Mahlon Kerr, MD, FACS
Austin Plastic Surgeon
4.9 out of 5 stars 216 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.