How Can I Get my Diastasis Repair Covered- Its Not Cosmetic!

I'm 64"/95lbs and suffer from severe diastasis. It affects every aspect of my life because of the back pain,visibly protruding abdominal organs, and digestive problems. I have tried physical therapy and strengthening my core which has only further aggravated my condition. I'm suffering financially because its caused me to miss so much work and am in danger of losing my job yet insurance is denying this saying its a cosmetic procedure. I don't have excess skin or fat nor am I doing it for looks!

Doctor Answers 4

Repair Of Diastasis Recti Is Not Covered By Insurance

Diastasis recti does not in and of itself cause back pain and its repair is virtually never covered by insurance.  A ventral hernia which can lead to other medical problems, on the other hand, is a condition whose repair is universally covered.  You should consult with a plastic or general surgeon to see from which condition you suffer.

Louisville Plastic Surgeon
5.0 out of 5 stars 2 reviews

How Can I Get my Diastasis Repair Covered- Its Not Cosmetic!

Most likely the health insurance will be very resistant to offering coverage. Best plan is have a boarded PS and GS submitt a letter of predetermination to the health insurance company. Include a strong narrative, photos of affected area in differing positions, any scans. Than just maybe you can be approved. Best of luck. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Correction of weakened abdominal wall

It sounds as though your weakened abdominal wall (rectus diastasis) may need to treated by a general surgeon with a large piece of mesh. The synthetic mesh will support your abdominal wall and prevent your abdominal contents (intestines) from protruding forward. This is treated similar to an abdominal hernia. Since you don't have any excess skin, this may be handled by a general surgeon and could possibly be covered by your health insurance.

I recommend you consult with a board certified general surgeon.

Best wishes,

Dr. Bruno

William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 377 reviews

Diastatsis and Insurance Coverage

Great question. This will not be an automatic , you will need to check your insurance plan. The exclusive diagnosis of diastasis is not real common. Your symptoms will need to be documented, specialists will need also send in additional supporting letters. They may or may not cover it on your first go around, if denied it should go to an appeal process. Now the most important thing to remember is that a true diastasis surgery will have a tough recovery. A fair amount of discomfort, but...... It will likely help your symptoms greatly. Good Luck

Charles Virden, MD
Reno Plastic Surgeon
5.0 out of 5 stars 70 reviews

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