Could I Be a Candidate for my Insurance to Cover Rectus Diastatis Repair? (photo)

I have interstitial cystitis and have an interstim implant, bowel function issues, lower back problems where I have had injections and a sm abdominal hernia from my stomach muscles being separated after 2nd child. I look bloated/pregnant especially after I eat a big meal. Would repair of my abdominal muscles be considered by my insurance for a necessary repair. mine are split from top to bottom at least 2 inches apart and anything that bump into my stomach hurts. especially down around my bladder

Doctor Answers 8

Diastasis Recti Repair and Insurance Coverage?

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No, I do not think you will have any luck having insurance companies cover the repair of the diastasis recti. The good news, given your history and pictures, is that you should have a very nice outcome with tummy tuck surgery.

 Best wishes.

Insurance coverage for diastasis recti

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Unfortunately insurance companies usually do not cover an abdominoplasty or any part of it.  You can call your company and ask for claims representative they should be able to explain to you the limits of your policy. 

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Rectus Muscle Repair Is Not An Insurance Covered Procedure

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Insurance coverage for rectus muscle repair is an historic concept. Insurances no longer see muscle repair as a medical procedure. They cover a hernia repair but not muscle repair without a hernia. 

Rectus diastasis and insurance coverage

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Insurance companies deem repair of your muscles (correction of rectus diastasis) as not medically indicated - hence it is rarely covered by your insurance.   It is difficult to make any recommendations from your photos alone.   Please visit with a board certified PS to learn more about your options.

Repair of rectus diastasis

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I agree that most insurance companies will not cover this.  I do think that the tightening and repair of the rectus diastasis improves core muscle tone and function and many of my patients have symptomatic back pain improvements as well; however, it has never been a covered insurance procedure in my practice.  I hope this helps.

Could I Be a Candidate for my Insurance to Cover Rectus Diastatis Repair

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Insurance carriers consider repair of diastasis recti a cosmetic procedure and therefore would not be covered.

Repair rectus muscle

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Most insurance companies do cover the hernia repair, but would not cover the diastasis repair or the removal of excess skin and fat. Pregnancy is a choice, and the repair is considered cosmetic. Some insurance companies may cover the abdominoplasty with the muscle repair if you have lost over 100 pounds. If you are considering surgery, I would suggest that you see a board certified plastic surgeon.

Connie Hiers, MD
San Antonio Plastic Surgeon
4.8 out of 5 stars 18 reviews

Could I Be a Candidate for my Insurance to Cover Rectus Diastatis Repair?

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All insurance carriers that I know of consider diastasis to be a cosmetic problem, not a medical one. The feeling is that there are no symptoms associated with the problem that interfere with health or function. Most physicians agree with their assessment. 

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

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.