I have a severe rectus diastasis, 3.5 cm, is surgery medically necessary?

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

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

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

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.

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.