Can diastasis recti be considered a hernia when billing insurance?

I'm wondering if my diastasis recti is severe enough to be called a hernia. Who decides what is considered a hernia?

Doctor Answers 7

Diastasis Recti

Thanks for your question. Diastasis recti is not a hernia... and will not be covered by insurance because it would be considered a cosmetic procedure.

All the best,

Dr. Results
Miami, FL

Can diastasis recti be considered a hernia when billing insurance?

A diastasis recti is not a hernia and cannot be billed as such without committing insurance fraud.
                                         

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Diastasis recti and insurance

Diastasis recti is NOT a hernia.  As a result, insurance does not consider the repair to be medically necessary, and insurance companies don't cover this service.   Though it can create a significant cosmetic and functional improvement in the abdominal wall, the repair is a cosmetic procedure.  

Joseph Franklin, MD
Durham Plastic Surgeon
5.0 out of 5 stars 8 reviews

Can diastasis recti be considered a hernia when billing insurance? No.

I have never had an "insurance" entity authorize tummy tuck surgery or plication of the abdominal wall muscles. In other words, insurance companies do not consider this operation medically necessary. Best wishes.

Can diastasis recti be considered a hernia when billing insurance?

No...they are two completely different issues and passing off a diastasis recti as a hernia would be considered insurance fraud. Hope this helps!

Can diastases recti be considered a hernia when billing insurance?

Diastases recti refers to a widening of the connection of the 2 rectus muscles. 2 rectus muscle run from the rib cage down to the pubic bone. They are normally between 5 and 7 cm in width. Very typically after pregnancy this connection between the 2 muscles can widen. This widening is not considered a hernia and normally is not covered by insurance. A hernia refers to a weakening of an area usually in the abdominal wall. This weakening can result in a pouch that protrudes from the abdominal wall. A protruding pouch type of defect would be regarded as a hernia and it's repair could possibly be covered by insurance.

John J. Edney, MD
Omaha Plastic Surgeon
4.8 out of 5 stars 108 reviews

Diastasis recti is not a hernia

It is not a hernia and will not be covered by insurance as it is a cosmetic procedure .  A hernia is evaluated on examination and can also be determined by a CT scan.

Anh Lee, MD
El Paso Plastic Surgeon
5.0 out of 5 stars 26 reviews

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.