When is diastasis recti considered a medical necessity so covered by insurance? (photos)

Question

I went to general surgeon today thinking I had a huge hernia, but found out it is diastasis recti, and that they no longer do the repairs on this. I look nine months pregnant, I am in agony, can't breath well, and my whole stomach region hurts. I can't bend over or exercise so I have put on 100 lbs. Lots of flab and I feel completely deflated that I may have to remain in this discomfort. It has been ten years now and my stomach grows larger and larger.

Francis X. Fleming, MD · Answer

For insurance to cover a surgical problem it must be a functional one. In your case, you may have diastasis recti, but your symptoms are due to intra-abdominal weight gain, which will not be changed by tightening you rectus muscles. If you were able to loose the weight that you have gained, then your muscles could be repaired to improve your abdominal contour, which would be considered cosmetic in nature.

Susan Buenaventura, MD, FACS · Answer

The diastasis is a weakness in the abdominal muscle ( stretching) that can be corrected with surgical repair to reposition the muscles.   Insurance does not cover this as it is not a hernia.   It is usually combined with a tummy tuck.   It's worth it!   Get a consult with an ASPS board certified plastic surgeon.

Ziyad Hammoudeh, MD · Answer

I am sorry to hear about the difficulties you are having.  Diastasis recti is when the rectus abdominis muscles can become spread apart from weight gain or pregnancy.  Intraabdominal contents then bulge through the space between the rectus muscles.  The rectus muscles can be sutured back together to close off this space as part of a tummy tuck.  Unfortunately, diastasis recti repair is not considered a medical necessity and therefore not covered by insurance.
Ziyad Hammoudeh, MD

Jeffrey Claiborne, MD · Answer

Rechandle:
I am very sorry to hear about your stomach symptoms. Unfortunately, repair of your rectus muscles is not typically covered by insurance companies (at least, I have never had success in getting it covered and neither have my peers).

Kenton Schoonover, MD · Answer

Diastastis recti is not typically covered by insurance.  Repair of the rectus muscles is typically done during a tummy tuck.  The best course of action for you would be to make an effort to lose some of the weight you have gained in order to allow for a better repair of your abdominal muscles.  I understand that weight loss is difficult, especially when you have difficulty being active.  Dietary changes by far are the most important aspect of weight loss though.  If you need help with weight loss, then I would recommend consulting with your primary care doctor for some help and guidance.  Once you have taken off a substantial amount of the weight, then I would recommend discussing treatment of your abdomen with a board certified plastic surgeon.

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