Will Insurance Cover Tummy Tuck For Diastasis Recti?

Hello ChristyInsurance will not cover tummy tuck to address underlying muscle problems. I would be leery of any physician who would offer to try to bill insurance for the repair while providing a tummy tuck. As diastasis recti repair is included with tummy tuck, such billing would be perceived as fraud.  The only possible way of getting the tuck covered would be a panniculectomy, which is the removal of infected loose skin on the abdomen. However, rectus diastasis repair is not included with panniculectomy, which again brings up the problem of billing issues with insurance. Find a board certified plastic surgeon, and get the procedure done properly. Have a great day!Matthew C Camp M.D.

Unfortunately, insurance does not cover a tummy tuck. Occasionally with documentation of recurrent infection they will pay for a panniculectomy (simply removing loose skin).#tt#tummytuck

Thank you for your question.

Each insurance plan is different and the only way to know if they will cover the procedure is to call and ask.  You will also need to find a surgeon who will perform the procedure under insurance as well.

In my experience, I have not found that insurance covers this procedure.

Good Luck!

At most, your insurance MAY cover repair of your diastasis of the abdominal muscles - and according to their fee schedule. That is something that you or your plastic surgeon would need to check on. Your insurance company will definitely not cover the tummy tuck itself.

Dear Christy568,  It is unlikely that your insurance carrier will cover the costs for repairing your diastasis.  A diastasis is an accepted consequence of pregnancy and rarely causes a functional problem that requires a repair that would be covered by your insurance.  Also, a diastasis is not the usual cause for abdominal pain with exercise or pressure but it is possible you may have a hernia-most commonly an umbilical hernia-that may need repair.  Still it is very unlikely that your insurance carrier would cover anything more than the OR time for the hernia repair and not the entire cost for an abdominoplasty.  Good luck.

Diastasis recti is separation of the abdominal muscles along the midline of your abdomen, most commonly caused by multiple pregnancies.  It is common during the tummy tuck operation to tighten the abdominal muscles to correct the diastasis.  However, it is so common after pregnancies, that it is doubtful that insurance companies cover repair of the condition.  It might be considered a normal sequelae of multiple pregnancies.

and your particular insurance company.  Surgery is more likely to be covered if the operation is considered functional, or directly related to symptoms you might be having.  In particular, chronic pain or infection, documented by notes from visits to other medical practitioners, can be helpful in demonstrating that the surgery is functional rather than cosmetic.  When you have this documentation, you should schedule a consultation for the diastasis repair.  A pre-determination letter with pre-operative photographs will be sent to your company and they will let your physician know if you meet the criteria for coverage.  If your request is turned down, you can appeal the decision.  Good luck....

Diastasis or separation of your mid line abdominal muscles after pregnancy is quite common. Although it is usually repaired with tummy tuck surgery, insurance is not likely to pay any of the fees.

Your symptoms and presentation should be evaluated by a specialist in back pain, such as a Physical Medicine and Rehabilitation specialist.  You note pain in the front of your abdomen.  Separation of the abdominal muscles, if the gap between the muscles is large enough, may cause BACK pain because of an imbalance between the rectus muscles and the paraspinal muscles.  If  such a specialist can correlate your symptoms and physical findings to a FUNCTIONAL IMPAIRMENT such as back pain, there may be a possiblility that insurance could cover this situation.  If your symptoms are all localized to the front of your abdomen, you may not have enough medical evidence to support insurance coverage of your problem.

 

There is a recent article from the January 2011 issue of "Plastic and Reconstructive Surgery" about the WARP abdominoplasty for back pain which may be of help to you.  Please seek it out for more information.

 

Good Luck!

Your health insurance will not cover your tummy tuck even if you have, as you claim, a symptomatic diastasis recti.  Even if you coulod convince your insurance company that it should be covered, you are unlikely to find a plastic surgeon willing to perform the surgery for the fee that they pay.