How Can I Get Surgery For My Diastasis Recti if Doc Says I Need it, But Medicaid Won't Cover it? (photo)

I have had three babies almost back to back and nursed the entire time. I have severe Diastasis Recti and it causes awful pain in my stomach, abdomen, and back all day everyday but I have medicaid and they say the surgery is needed but they won't cover it. How can I get the surgery I need? I am a full time mommy and college student and my fiance is a painter that struggles to pay our bills. I just want to stop hurting and be able to hold my babies!!!

Doctor Answers 1

Medicaid will not cover a tummy tuck, but may cover a hernia repair.

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I'm sorry to see your severely stretched abdominal wall fascia, and understand that pain can certainly be a part of this degree of stretch and protrusion. But, as a reviewer for Medicare/Medicaid for many years, I can tell you that pain alone is very subjective and is not sufficient to qualify for insurance reimbursement (or Medicaid coverage).

A true hernia (not just stretching of the abdominal wall fascia, even if severe) can be symptomatic, medically dangerous, and does qualify for repair and insurance or Medicaid coverage in many if not most cases. A general surgeon would be the most common surgical specialist to perform this operation, and s/he would use a vertical midline incision. All your loose skin would remain, and you would still be a candidate for elective cosmetic tummy tuck surgery (self-pay).

If you live near a university or major medical institution that trains plastic surgery fellows, you may be able to find lower-cost tummy tuck surgery performed by a supervised plastic surgeon-in-training. If not, start saving those dollars, try to lose weight, do not smoke or stop if you do, and you may be able to reach your goal sooner than you think. Best wishes! Dr. Tholen

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.