Diastasis recti. Will my insurance help if a plastic surgeon does my surgery?

This condition causes me lower back pain, constipation, and urine leaking, now I think I have a hernia because of it. I cannot understand why this is not considered a medical condition. If I'm having another abd surgery then I'm getting my tummy tucked too. I've had 3 C-sections and several lap scopes. My last baby was born 23 years ago!! will my insurance help if a plastic surgeon does my surgery?

Doctor Answers 18

Insurance is based on the condition not the surgeon

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If you are going to have a tummy tuck, it must be performed by a plastic surgeon or you will compromise your outcome.  Go to the University Hospital and have the Plastic Surgery Department evaluate your situation.

Insurance and abdominoplasty

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Insurance companies do two things very well: collect premiums and deny claims. My experience suggests that if one has a procedure that is deemed medically necessary, such as a hernia repair, and a cosmetic procedure is added on, the insurance company will pay only for the medically necessary procedure. However, the second procedure will likely cost less than it would if it was a stand alone procedure because you are already there in the O.R. and already asleep- and that saves a lot of time.

William H. Gorman, MD
Austin Plastic Surgeon
4.0 out of 5 stars 19 reviews

Diastasis recti. Will my insurance help if a plastic surgeon does my surgery?

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Thank you for your question.  Unfortunately coverage of a procedure will depend more on the underlying condition rather than the operator who repairs the issue and in most cases a diastasis is not deemed medically necessary by an insurance carrier and will not be covered.  I would recommend reaching out to your specific carrier to see if they would cover the procedure but most likely they will only cover repair of a frank hernia.  Hope this helps.

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 80 reviews

Diastasis recti. Will my insurance help if a plastic surgeon does my surgery?

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If you do have a hernia, your insurance will likely cover the hernia repair.Kenneth Hughes, MDLos Angeles, CA

Diastasis recti. Will my insurance help if a plastic surgeon does my surgery?

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This is a hard problem as insurance companies do not cover it. I have patients whose back pain and urinary leaking improved after a diastasis repair but insurance would not cover it. See an experienced plastic surgeon and link below for examples. 

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 76 reviews

Will need to get predetermination of benefits letter

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You will need to see a surgeon and possibly get a CT scan to confirm the presence of the hernia and then submit a predetermination of benefits letter to your insurance company to see if it is covered. In most instances they will not provide coverage.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Insurance and cosmetic surgery

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Hi OnederfuloneInsurance does not cover cosmetic surgery, that will be in your contract that you signed with them.  A diastaisis recti simply means stretching of the abdominal wall strength layer.  It is not a hernia, and is not typically associated with any of the symptoms you describe. I would recommend getting a thorough exam to see if you have a hernia (repair usually covered by insurance), and also to evaluate your urinary incontinence.  Low back pain can be difficult to diagnose, and again, if problematic to you, and especially if you have nerve signs and symptoms, please get checked out.
Sorry I don't have better news for you.

Diastasis recti

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Diastasis recti is not a covered procedure.  Most surgeons are paid directly for an abdominoplasty. These are not covered by insurance.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Diastasis Recti repair during an abdominoplasty

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Thank you for your question. Your surgeon would need to
examine you to determine if you do in fact have a hernia. If you have a true
medically necessary condition, such as a hernia, insurance may cover it. If
you simply have diastasis recti, then it could be considered fraudulent to bill
for a non-medically necessary procedure. An abdominoplasty included plication
(tightening) of the abdominal muscles. If you have a hernia, this would be
repaired as part of the abdominoplasty. If you did want your  insurance  to cover the hernia, it may cost more in the
long run. This is because your surgeon will still charge for the abdominoplasty
and the facility and anesthesiologist will still charge for the CPT code for
the abdominoplasty. Then your insurance company would be billed for the surgeon’s
fee, anesthesia fee and the facility fee for the hernia CPT code. If you have a
deductible or co-insurance you would be responsible for those as well. Talk to
your surgeon to look at your options. Good luck to you.


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Abdominoplasty is not a procedure covered by insurance. Insurance does not consider diastasis correction medically necessary.Be sure to make arrangements for consultation with a board-certified plastic surgeon to discuss your questions, concerns, details of the procedure and your expected outcome. Best of luck to you.

Emily J. Kirby, MD
Fort Worth Plastic Surgeon

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.