Is abdominoplasty with muscle repair ever covered by insurance?

Question

I have severe diastasis from my pregnancies - a five finger separation. I saw only minimal improvement after months of PT exercises and I'm fairly certain that I have a hernia. Is there any chance at all of having insurance cover at least part of the repair? Although I want to look better, my motivation is not only cosmetic - I want to be able to fully use my ab muscles again! Thanks for any advice!

Kamran Azad, MD · Answer

Thank you for your question. Unfortunately recti diastasis is not covered by most insurances and isn't considered a hernia. If you have a separate issue of a hernia, that could be covered to be repaired by a general surgeon prior to your tummy tuck. Some PS can fix a hernia during a tummy tuck surgery, but that would not make the tummy tuck and associated costs covered by insurance. Good luck!

Susan D. Vasko, MD, FACS · Answer

Great question, and one many patients ask. Insurance will cover a hernia repair, however, they will not cover diastasis repair or a tummy tuck. Your plastic surgeon may repair your hernia themselves, or they may have you schedule a combo surgery where a general surgeon would do the hernia repair (and bill to insurance) and the plastic surgeon would do the diastasis repair and tummy tuck (paid out of pocket as cosmetic). Be sure to schedule a consult with a board certified plastic surgeon.

Kenneth Hughes, MD · Answer

Although cosmetic procedures (abdominoplasty with muscle repair) are never covered by insurance, certain procedures, most commonly incisional or umbilical hernia repair, are reimbursed at a minimal rate.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA.

Francesco Campanile, MD · Answer

Unfortunately, it’s unlikely that your insurance will cover your tummy tuck, even if it is to repair muscle separation. If you do have a hernia, insurance should cover a hernia repair, but not your tummy tuck. I would discuss your needs with your plastic surgeon in detail to help you determine the best approach. He or she may suggest having the hernia repaired prior to your tummy tuck, rather than wrapping both procedures into one. Wishing you the best of luck!

Tania Medina de Garcia, MD · Answer

Hello dear!!   Thanks for the question and provided information as well.    Insurance does not cover elective plastic surgery. However i recommend you discuss your case with your insurance company.   Good luck.-

Brian A. Pinsky, MD, FACS · Answer

Unfortunately, insurance companies view muscle separation or diastasis as a cosmetic issue and do not cover abdominoplasty or diastasis repairs as it is not a true hernia.  It does seem arbitrary in this circumstance as cosmesis may not be your motivation to seek surgery, but these are the rule we must follow.  I recommend an evaluation with a board certified plastic surgeon to discuss you options.  Good luck!

Israel Manon, MD · Answer

Hi, plastic surgery in general are not covered my insurance, TT included. If you are still willing to get into surgery I recommend you to consult a certified plastic surgeon and coordinate which procedures will fit your needs.
Regards
Dr. Israel Mañon                                                     
Certified Plastic Surgeon

Richard J. Brown, MD · Answer

No, They do not see this as a functional problem. They see it purely as cosmetic. Despite your thinking it is medical they just simply do not see it that way. You can try but I promise you it will be denied. And, I don't really know any well trained plastic surgeon that would accept insurance reimbursement for really a cosmetic procedure. All of us know we would end up not being paid for the work. I hope you find what you need. Best of luck.

Steven Wallach, MD · Answer

A diastasis is not considered a hernia by insurance, and therefore you would have to pay for this yourself.  This can be done as part of a tummy tuck.

Rick Rosen, MD · Answer

The only part of the procedure that insurance will cover is if there is a true hernia, not a diastasis. A true hernia, where the fascial layer is gone, is a medical condition that they must cover. A diastasis however, the fascial layer is there but stretched out. That is not a medical condition that may lead to complications if not repaired in their opinion. It will cover some of the OR and Anesthesia costs if you have a true hernia.

Is abdominoplasty with muscle repair ever covered by insurance?

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