I have 2 children, both via C-section. I have a 3-4 finger width separation between abdominal muscles. It is very uncomfortable, especially after i eat. It also is painful when I cough, or sneeze. I really would like to have repaired, but I am concerned it will be all out of pocket and insurance will not cover it. Can you please give me some insight?
Is Diastasis Recti Repair Covered by Insurance?
Doctor Answers 12
Insurance and Abdominoplasty
Most insurance companies do not cover this procedure as they consider it cosmetic. Insurance companies are becoming more and more strict on what procedures they cover and whether or not it is a medical necessity. More than likely this will be something that you will have to pay out of pocket for.
Rectus Diastasis Repair
Rectus diastasis repairs are deemed not medically necessary by insurance companies. Hence, it is consider a cosmetic self-pay procedure.
Only hernia repair is covered by insurance. Diastasis is a general relaxation of the muscles and tissues around it. this not covered by insurance. The reason hernias are covered is that a piece of bowel can be caught in it, and if the tissues swell and the circulation of the bowwel is geopardised then a big problem would occur. This would not happen with diastasis recti.
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Is Diastasis Recti Repair Covered by Insurance?
It would be most unusual today for a diastasis repair to be covered by insurance. It is widely considered a cosmetic procedure without medical indications. and without evidence that treatment has anything but cosmetic benefits.
Hernias on the other hand have health risks and their repair has clear medical benefits, and those operations are covered by most policies. If a tummy tuck is done at the same time, ti will not be covered. (I have seen patient bills where their co-pay for the OR and anesthesia time for the hernia portion is more than the cash fee would have been had insurance not been involved.)
Your physician can help you sort out whether this is a diastasis or a true hernia.
Thanks for your question, best wishes.
Diastasis Recti Repair is a cosmetic procedure.
Diastasis Recti repair is not recognized as a "medically necessary procedure" by insurance carriers. It is a procedure that is performed as part of a larger operation called an abdominoplasty (tummy tuck), which is cosmetic and is paid for by the patient..
Diastasis is usually not covered by insurance
The only thing that I would add to the excellent responses from the other plastic surgeons listed here is that even if the diastasis or hernia repair was to be covered, the rest of the abdominoplasty would not be covered. Patients often believe that if the hernia or diastasis is covered then the facility and anesthesia fees will be covered so that the abdominoplasty will cost less. Insurance companies look at the anesthesia and OR nurses records to see what time the cosmetic procedure was being done and at what time the reconstructive procedure was done. If the hernia takes 30 minutes and the abdominoplasty takes 2 hours, the patient ends up paying for 2 hours of OR and anesthesia time. A diastasis repair or a hernia repair is not the same as an abdominoplasty and this is often confusing to prospective patients.
Diastasis Recti Is Not Usually Covered By Insurance
Dear Tricia in PA,
Unfortunately, even symptomatic diastasis is not covered by insurance. However, if you have a hernia, you may be able to get coverage for this problem. I would suggest a consultation with a general surgeon to determine if you have a hernia. If not, most plastic surgeons repair the diastasis at the time of a tummy tuck. This would be an out of pocket expense however. Good luck.
Diastasis repair is not usually covered by insurance, but make sure it's not a hernia!
Thanks for your question. Unfortunately, diastasis recti is not covered by insurance even if it causes pain, swelling, bloating, deformities, back pain, etc. More studies need to be done to prove the benefit of repairing the separation of the muscles. However, from your symptoms it sounds like you may have a hernia. A hernia repair is covered by insurance, so have your plastic surgeon or general surgeon examine you to determine whether or not you have a hernia. If you do, a tummy tuck can be performed at the same time to tighten your abdominal muscles and to remove any excess skin from your abdomen. Even though this part is not covered, some of the time in the operating room will be covered by the insurance company. Financing options are also offered by many plastic surgeons. We have great financing options, and I frequently perform tummy tucks with other procedures, like a hernia repair, OB/GYN procedures.
Rectus Diastasis Repair Rarely Covered by Insurance
In the past, I had occasional cases where a patient with significant symptoms had insurance coverage of a rectus diastasis repair (but not a complete abdominoplasty). However, this is much less common now.
You and your primary care physician may want to start documenting your symptoms and then ask your insurance company if they would consider covering it if your symptoms do not improve. You may be asked to try physical therapy first.
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.