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?
Answer: Diastasis repair Hello Thank you for your question. Unfortunately, diastasis repair is usually not covered. However, if it is causing you too much pain it would be best to discuss your concerns with your MD. Best regards
Helpful 1 person found this helpful
Answer: Diastasis repair Hello Thank you for your question. Unfortunately, diastasis repair is usually not covered. However, if it is causing you too much pain it would be best to discuss your concerns with your MD. Best regards
Helpful 1 person found this helpful
Answer: Diastasis Things like heartburn and limitations to exercise shouldn't really have anything to do with a gap between the muscles. I have never seen it covered by insurance, but certainly if you have any issues related to your umbilical hernia repair, I would discuss that with your general surgeon. A year and a half out from surgery, you should no longer has significant limitations to exercise or daily life. Talk with your general surgeon.Best of luck!Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA
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Answer: Diastasis Things like heartburn and limitations to exercise shouldn't really have anything to do with a gap between the muscles. I have never seen it covered by insurance, but certainly if you have any issues related to your umbilical hernia repair, I would discuss that with your general surgeon. A year and a half out from surgery, you should no longer has significant limitations to exercise or daily life. Talk with your general surgeon.Best of luck!Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA
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May 12, 2016
Answer: I have a severe rectus diastasis, 3.5 cm, is [tummy tuck] surgery medically necessary? I am sorry to hear of your difficulties, but subjective complaints will not obtain insurance reimbursement for tummy tuck (regardless of muscle repair). Even if you had a symptomatic ventral hernia, the most insurance would cover is a midline incision for hernia repair, mesh as needed, by your general surgeon. This is far from a cosmetic tummy tuck, for which insurance coverage will not be obtained, pretty much regardless of provider or cost of your policy.BTW, the heartburn will only be worse after tummy tuck with muscle repair, so this would need to be addressed by your primary physician of gastroenterologist separate from any sort of elective tummy tuck surgery.Sorry, but you are going to have to pay for your tummy tuck on your own, just like everyone else. Best wishes! Dr. Tholen
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May 12, 2016
Answer: I have a severe rectus diastasis, 3.5 cm, is [tummy tuck] surgery medically necessary? I am sorry to hear of your difficulties, but subjective complaints will not obtain insurance reimbursement for tummy tuck (regardless of muscle repair). Even if you had a symptomatic ventral hernia, the most insurance would cover is a midline incision for hernia repair, mesh as needed, by your general surgeon. This is far from a cosmetic tummy tuck, for which insurance coverage will not be obtained, pretty much regardless of provider or cost of your policy.BTW, the heartburn will only be worse after tummy tuck with muscle repair, so this would need to be addressed by your primary physician of gastroenterologist separate from any sort of elective tummy tuck surgery.Sorry, but you are going to have to pay for your tummy tuck on your own, just like everyone else. Best wishes! Dr. Tholen
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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.
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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.
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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.
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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.
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