Diastasis/Hernia and TT. Can Insurance Help? (photo)

I've lost 40 pounds this year and discovered my ab muscles appear to be deformed. A GS told me I have an umbilical and ventral hernia as well as diastasis. He says stop exercising! He wants to repair hernias with a vertical incision from sternum to BB. He will not fix diastasis. I have some loose skin from pregnancy so am considering a TT as well. PS I have contacted do not deal with insurance. How can I get insurance to cover at least hernia repair? Should I really stop working out?

Doctor Answers 7

Diastasis/Hernia and TT. Can Insurance Help

The hernias and diastasis repairs can readily be fixed through a tummy tuck incision, which is much less noticeable than a vertical incision would be. Typically the insurer will pay for the hernia repairs, but not for the tummy tuck, though the tummy tuck typically includes a diastasis repair.  

One possibility is to pay out of pocket for the TT which could be done at the same setting as the hernia repair. Another is contacting your insurer for a plastic surgeon who is in their network. That surgeon could decide about whether he/she is comfortable repairing the hernia or whether bringing in a general surgeon would be better for you.

Thanks for your question, best wishes. 

Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

Insurance should cover hernia, maybe abdominoplasty.

I treat patients like you often. An abdominoplasty approach to your hernia and diastasis repair. As both a board certified plastic surgeon and board certified general surgeon, I perform these procedures with insurance preaproval.

Frank Agullo, MD
El Paso Plastic Surgeon
4.9 out of 5 stars 140 reviews

Abdominoplasty with Mesh Reinforcement

You are an excellent candidate for Abdominoplasty with Mesh Reinforcement to restore your abdominal wall.  There are recently published articles in Plastic and Reconstructive Journal describing this technique.  The advantages of this technique is it is done through a low transverse incision, not the vertical incision that a GS would use.  Large mesh is used to reinforce the abdominal wall and is sutured laterally to give a more hourglass figure and more stable fixation.  Working out increases intra-abdominal pressure which can cause the intestines to get trapped inside the hernia sac and become obstructed.  Until your hernia is resolved, it would be a good idea to not work out.  The hernia will be covered by insurance.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 222 reviews

Hernia repair with tummy tuck

Insurance companies very seldom pay for a diastasis repair but might pay a little bit if you do actually have a true hernia.  Any way you go about it, you will never win with the insurance company if you have a tummy tuck done.  The insurance companies are wise to this after dealing with it for many years.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Hernia repairs with tummy tucks

are done frequently.  As mentioned, most plastic surgeons have experience in repairing ventral and umbilical hernias.  Mixing insurance and cosmetic procedures can be tricky.  If you are dead set on trying to get insurance to cover some of your procedure, I would suggest getting a general surgeon or qualified plastic surgeon that accepts insurance and coordinate procedures.  In my neck of the woods, if someone scheduled a tummy tuck with me and am willing to give up their belly button, I am happy to repair the umbilical hernia at the same time as well a small ventral hernias.  Larger hernias are left for the general surgeon.  Good luck with your search!

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Hernia and abdominoplasty.

You appear to be a wonderful candidate for the combined procedure. Hiding the scar in a low horizontal location is far better cosmetically than a long vertical scar proposed by your GS and accomplishes the reconstructive hernia repair and cosmetic abdominoplasty.. Most Board Certified PS have experience in both and typically private practice surgeons have much more cosmetic experience.

Do your research and find a Plastic Surgeon with whom you feel comfortable and has good references and willing to show you before and after photos of their work.

Brian J. Lee, MD
Fort Wayne Plastic Surgeon
5.0 out of 5 stars 12 reviews

Insurance for hernias

Speak to your insurance company and ask them what plastic surgeon works with their network in your area.  Often the university hospitals have surgeons participating with more companies than the docs in private practice.  Good luck!

Evan Sorokin, MD
Cherry Hill Plastic Surgeon
4.8 out of 5 stars 76 reviews

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.