Do you think, because of my spinal condition and pain, insurance would cover surgery for my diastasis recti?

Question

I have diastasis recti from my recent pregnancy. I also have Hyper Lordosis of my spine. Before the diastasis my ab muscles were constantly strong to help my back muscles keep my spine from collapsing and arching more. The back pain from the lack of ab muscle strength is, at times, unbearable. My body, because of my spine, is still trying to use my ab muscles which is making diastasis worse.

Kenneth Hughes, MD · Answer

There is always a possibility that you will have an improvement in back issues with a tightening of the abdominal wall but it is not guaranteed. It's doubtful that medical insurance would cover the surgery for diastasis recti repair.

Chad Deal, MD · Answer

It is possible that they could cover this if they believe that it would fix your condition. However, I would find this to be unlikely as it is mostly a cosmetic procedure unless there’s also a hernia developing in the diastasis.

Farbod Esmailian, MD · Answer

Diastasis recti is when the rectus or six pack muscles separate away from the midline either due to pregnancy of massive weight loss or at time genetics.  This separation, if severe, causes the muscle to not function properly.  Many patients state that the lower back pain is improved or resolved after repair.This procedure can be performed along a tummy tuck procedure or separate from such a procedure by making a smaller incision, similar to a c section and performing the repair that way.This procedure is still considered cosmetic as there is no procedure code to document this.  Therefore insurance companies will not cover this procedure.Hope that helps.

Daniel Barrett, MD · Answer

Dear Mommamack19,
it is unlikely that your health insurance will cover the costs for diastasis recti repair. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Rady Rahban, MD, FACS · Answer

Hello, 
Thank you for your great question!  I have worked on a number of patients who suffer from diastasis recti to varying degrees from mild to severe.  I have had great outcomes using a meshless approach to correcting the diastasis as well as existing hernia(s).  Many patients have expressed relief to their lower back as correcting the connective tissue back to the midline brings back the proper anatomical structure of the abdomen, allowing for greater function of the core as a whole.  I recommend seeking out a Board Certified Plastic and Reconstructive surgeon with extensive experience with correcting DR. 
In terms of insurance coverage, unfortunately, there is no code for diastasis recit repair specifically. Unsure if your preexisting condition will impact coverage but have yet to see DR repair get covered as most policies see diastasis recti repair as a cosmetic procedure.

Do you think, because of my spinal condition and pain, insurance would cover surgery for my diastasis recti?

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Do you think, because of my spinal condition and pain, insurance would cover surgery for my diastasis recti?

Answers (6)

Answer: Diastasis recti

Answer: Diastasis recti

Answer: Insurance Coverage for Diastasis Recti

Answer: Insurance Coverage for Diastasis Recti

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Recommended reading

Everything you need to know about Diastasis Recti Repair

Our mission is to create a world where every investment in modern beauty is Worth It.