Why is Diastasis Recti Repair Not Covered by Insurance?

Great question. Call your insurance company for their position. Have a PS write a letter of predetermination for you. OR just pay for the operation.

From MIAMI DR. B

"If I had ripped my arm or leg muscles apart in an accident - that would be covered"

GREAT question but - Answer - not what you want to hear.

A health insurance policy is in fact a contract between the company and you or your employer. The type and amount of health care costs that will be covered by the health insurance company are specified in advance, in the member contract or "Evidence of Coverage" booklet.

Each company, as an independent business, has the legal right to decide what it will pay for and what it will not. Similarly, as a consumer you have the right to decide which insurance product you want to buy and which you will not. When YOU signed your contract (Health care policy) you agreed to pay for its listed services. The mere fact that you have an insurance policy does NOT mean that it includes everything and "covers". To make this point clear, each policy has its own long list of EXCLUSIONS - of services are which are not covered. If you buy a plan with an excluded service which you would like to have (such as cosmetic surgery, certain fertility services, certain psychiatric services, certain experimental medical services (IE face transplants etc), it will not be paid for and you are generally expected to pay the full cost of non-covered services out of your own pocket.

However, unfair or distasteful it may seem. There is nothing wrong with getting what you paid for.

But - many doctors have a real issue when insurance companies do not pay for "covered" services which they are SUPPOSED to pay for. This is frequently a problem as well and one that we need to vigilantly fight.

At present, cosmetic surgery is NOT paid for/covered by ANY insurance plans. It is clearly excluded and this is made clear when you purchased the plan. Putting the tummy muscles together is a cosmetic operation to make you look better. You therefore have a choice of not having or having it and paying for it yourself.