Ventral & Umbilical Hernia - How Can I Get my Insurance to Also Cover a TT? (photo)

I recently had a consultation with a board certified plastic surgeon. I have a large ventral hernia and a small umbilical hernia. He straight up said that insurance will NOT pay for the TT portion after I was told that my insurance carrier would by the office manager prior to the 2-hr drive. The PS did say that I will have no bb unless one is created during TT. How can I find a PS out there that will attempt to work with my ins. provider? Is there no way to bill it as necessary reconstruction?

Doctor Answers 14

Insurance and TT

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

Combining hernia with tummy tuck

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Insurance companies will never cover a tummy tuck since it is cosmetic.  However, you will save money if you pay for a tummy tuck at the time of the hernia repair.  Since most of the surgery is done to correct the hernia, the tummy tuck will add only 1 hour to your surgical time.  This cost should be about $1,000 to $2,000 for facility and anesthesia and the surgeon's fee would be about another $1,000 to $2,000.  It is possible that you could get the tummy tuck done at the same time fo your hernia repairs for an additional $3,000.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Insurance may cover a hernia or panniculectomy

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Thank you for the question and photos.  Health insurance does not cover cosmetic surgery and a tummy tuck is a cosmetic procedure.  Your insurance company may cover a hernia or a panniculectomy if that is the case.  At that time you may choose to pay the difference and have the tummy tuck also performed.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Tummy tuck covered by insurance

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We get this question asked quite frequently.  For the most part, insurance companies do not pay for this procedure and are quite wise to the fact that many patients try.  You can go through the motions of pre authorization if you wish, but in 99 percent of the time they do not cover the procedure. In those cases where a true hernia is present, it may pay a small portion of the entire procedure.  For he most part, however, it is considered a purely cosmetic operation. 

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 30 reviews

Insurance coverage for a tummy tuck

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A tummy tuck is a cosmetic procedure so unless you have insurance that covers cosmetic procedures (which I believe exists but is very expensive) trying to get your insurance to pay for a cosmetic procedure is fraud and no reputable plastic surgeon should be willing to do it.

Margaret Skiles, MD (retired)
Sacramento Plastic Surgeon

Insurance Coverage For Abdominoplasty

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Thank you for the question and the pictures.To address the first part of this inquiry, I am not aware of any insurance carrier that will consider coverage of an abdominoplasty (tummy tuck) procedure. Your hernia repair is considered a medically necessary procedure while the abdominoplasty is cosmetic in nature.

As for the second part of the question. You are asking if there is a plastic surgeon that will lie and in essence commit fraud to try and get the abdominoplasty covered. I would have to ask you then if you would be comfortable putting your life in the hands of a person that you already knew was willing to lie to your insurance company? Why would they not lie to you?

From your photos it would appear that an abdominoplasty would be most benenficial. If the surgeon you consulted with is not to your liking, get a second opinion. You can find a list of Board Certified Plastic Surgeons that are on your plan from your insurance company. Best of luck.

How Can I Get my Insurance to Also Cover a TT

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Almost all insurers will pay for medically necessary surgery. A hernia would typically be considered necessary. A tummy tuck would be considered cosmetic. 

Your insurance company should have a list of plastic surgery providers with whom you can consult. However, there is no way that I can see that any surgeon would call the tummy tuck something other than what it is, a cosmetic procedure that doesn't reach the threshold of being called medically necessary.

Thanks for your question and for the photos. Best wishes. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Insurance coverage for tummy tuck is very unlikely

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True, insurance will cover hernia repair if required during a tummy tuck, however insurance coeverage for a tummy tuck is not something that is likely to happen. Is there a surgeon who can 'get it through'? Well, look at it this way. If a surgeon is willing to be untruthful to an insurance company, then he might be willing to be untruthful to you as well. Honesty is best. Your insurance plan will have a list of surgeons within your network of coverage and may be a place to start.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Ventral & Umbilical Hernia - How Can I Get my Insurance to Also Cover a TT?

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Your insurance carrier will cover repair of a true hernia based on your carrier's limits and your deductable. If you have a TT at the same time they will still cover only the hernia.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

You can't get it all covered... and be wary if you do!

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The answer is quite simple. Insurance doesn't pay for tummy tucks because they are cosmetic procedures.  They will pay for your umbilical hernia but probably not the vertical hernia (really called a diastsis recti or separation of the six-pack muscle) because this is not truly a hernia.  It is too bad you did drive that far for the consultation but at least you know where you stand.  I do think you would benefit grealtly from a tummy tuck in terms of your results.

I know people hear a lot of things when they talk to friends but I can tell you I have not had a tt paid for by insurance in the last 18 years.  They insurance will cover the OR and Anesthesia fees, but the hospital or facility and anesthesiologists will separate out the cosmetic portion and expect to be paid prior to surgery for that portion of the surgery that is cosmetic.  Good luck in your hunt for a surgeon who will do the procedure for only insurance.

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.