I have had umbilical hernia repair with mesh in Sept 2014. I went through 6 months+ of physical therapy until therapist said there is nothing else she could do. I have had lower back problems and slight digestive issues like heart burn since then. I have a 3.5 cm gap, pain about 90% of the time in my abdomen. I can't exercise the way I want because i have been told all the things to avoid. How do i get this surgery considered as medically necessary?
May 12, 2016
Answer: I have a severe rectus diastasis, 3.5 cm, is surgery medically necessary? Thank you for sharing your question and story and I am sorry to hear of your abdominal problems. The best course of initial action would be to contact your insurance company to see if they ever cover the cost of a diastasis repair. If they do cover the cost they should be able to tell you the criteria needed to qualify. I would then contact a board certified plastic surgeon to discuss your options at repair and have them obtain a pre-certification/determination approval for surgery. If your insurance company does not cover this procedure then you have the option of electing a different policy that does next year or paying for it as an aesthetic procedure. In most cases insurance companies will not designate a diastasis as medically necessary as compared to a hernia repair. Hope this helps.
Helpful
May 12, 2016
Answer: I have a severe rectus diastasis, 3.5 cm, is surgery medically necessary? Thank you for sharing your question and story and I am sorry to hear of your abdominal problems. The best course of initial action would be to contact your insurance company to see if they ever cover the cost of a diastasis repair. If they do cover the cost they should be able to tell you the criteria needed to qualify. I would then contact a board certified plastic surgeon to discuss your options at repair and have them obtain a pre-certification/determination approval for surgery. If your insurance company does not cover this procedure then you have the option of electing a different policy that does next year or paying for it as an aesthetic procedure. In most cases insurance companies will not designate a diastasis as medically necessary as compared to a hernia repair. Hope this helps.
Helpful
May 12, 2016
Answer: Medically necessary The answer depends on your insurance coverage. However, I can tell you that is very unlikely that you will have coverage or can find an experienced Plastic surgeon to do an abdominoplasty fully covered by insurance payment.I hope you find a solution.
Helpful
May 12, 2016
Answer: Medically necessary The answer depends on your insurance coverage. However, I can tell you that is very unlikely that you will have coverage or can find an experienced Plastic surgeon to do an abdominoplasty fully covered by insurance payment.I hope you find a solution.
Helpful
