Can a Diastasis Recti Repair Be Covered by Insurance?

Thank you for the question.

Your description certainly fits with the presence of an abnormal wall hernia;  despite the negative ultrasound, I would suggest further evaluation/workup to rule out the presence of the abdominal wall hernia (possibly missed on the ultrasound study).

Although it may be a challenging process, there is a chance that a severe diastasis rect may be a covered benefit through your insurance plan.  Your best bet would be to meet with well experienced board-certified plastic surgeons or in person consultation.  Your plastic surgeon will hopefully be able to document the necessity for surgery and provide this documentation to your insurance company.

 Best wishes.

 

I am sorry that you have this debilitating problem.  Unfortunately, diastasis recti is usually not covered by most insurance programs.  The only hope is to get a peer to peer review from your carrier.  You will need documentation of the problems that you are having in terms of doctor notes etc.  it is helpful to show pictures of your abdomen at rest and with valsalva (bearing down) to demonstrate how your muscle contract ineffectually and can sometimes push your intraabdominal contents outward.  A short video would be excellent.  The most difficult thing is that tricare is sort of like Medicare in that there is no preauthorization process.  Their customer relations will tell you that they will approve procedures that are medically necessary, but will then deny the payment after it has been done.  Lastly, they will ask why a plastic surgeon is doing the procedure and not a general surgeon.  Unfortunately, many of us on this website will nod our heads and say yes, been there tried that and it doesn't work.