I haven't been able to get even the most deformed nasty rectus diastasis covered for about three years on any patient. The problem is that although the diastasis does make your core weak, there is no true hernia, so you are not in any immediate danger of intestinal entrapment. Meanwhile, I truly believe that getting these fixed, especially when they are wide (>4cm) is incredibly important to health and well being, whether it be standing correctly, sitting up properly, not to mention avoiding problems as we age with posture and strength. The Ehlers Danlos may help, with a peer review, especially if you have a true umbilical hernia. You may benefit from mesh placement as well to try to give you better long term results- because in your case, your fascia may be inherently weak/stretchy from your collagen disorder. For the record I don't find it necessary the majority of the time.
Under Ontario public health insurance (OHIP), each application for coverage is considered on its own merits. you need to see a Plastic Surgeon who is willing to offer the surgery and make an application on your behalf.
It depends on your insurance. Check your insurance to see if tummy tucks
are specifially excluded from coverage (many policies have added this). Then See a Board Certified Plastic Surgeon for -
- a full exam,
- an insurance report with coding of all the problems noted above - there may be a fee
- if insurance denies, you can appeal.
- Insurance is likely to approve hernia repair. It will require you to use the surgeons on their panel for full insurance benefits.
Unfortunately, even though insurance companies say that they will pay if it is medically necessary, what they don't tell you is that, the INSURANCE companies decide what is medically necessary. Not the doctor, not the patient, and unfortunately, not the disease.
I think you should definitely have it covered. All I can suggest is to continue be a squeaky wheel - it helps.
Typically we have had difficulty getting any kind of abdominal wall or tummy tuck surgery covered by insurance. You certainly do have a number of contributing factors. Some of the things you had mentioned really don't have much to do with your abdominal wall but the prominence could be improved with repair of the diastases. This question is best answered via a thorough consultation with a board-certified plastic surgeon in your area. He can contact your insurance company to see if they will pay.