Will Insurance Pay for Hernia Surgery with Tummy Tuck?

Hello Liam, thank you for your question regarding combining hernia surgery with a tummy tuck.

It is quite common to combine hernia repair surgery with a tummy tuck (abdominoplasty). Many patients find this combination beneficial as it allows them to address both medical and aesthetic concerns in a single procedure, reducing overall recovery time and costs compared to having the surgeries separately.

Since your hernia surgery is medically necessary, insurance is likely to cover the portion of the procedure related to the hernia repair. Insurance companies generally do not cover the cosmetic portion of the surgery, such as the tummy tuck, as it is considered elective and not medically necessary. However, by combining the procedures, you can potentially reduce the overall cost you need to pay out-of-pocket for the tummy tuck portion.

Here are a few steps to consider:

Consult with a Plastic Surgeon: Make sure to find a board-certified plastic surgeon who has experience performing both hernia repairs and tummy tucks. They can evaluate your condition and provide a detailed treatment plan.

Insurance Approval: Work with your plastic surgeon's office to get the hernia repair pre-approved by your insurance company. This may involve submitting medical records, imaging studies, and a letter of medical necessity from your surgeon.

Cost Breakdown: Request a detailed cost breakdown from your surgeon's office that separates the hernia repair costs from the tummy tuck costs. This will help you understand what portion your insurance might cover and what you will need to pay out-of-pocket.

Coordination of Benefits: Some insurance plans have provisions for coordinating benefits when multiple procedures are performed at once. Be sure to discuss this with your insurance company to maximize your coverage.

Combining hernia repair with a tummy tuck can be an effective way to achieve your desired results while potentially reducing overall costs. However, it is essential to thoroughly discuss your options with your plastic surgeon and insurance provider to ensure you have a clear understanding of coverage and costs.

I hope this helps, and I wish you the best of luck with your upcoming surgery.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS

Unfortunately, insurance does not cover a tummy tuck. Occasionally with documentation of recurrent infection they will pay for a panniculectomy (simply removing loose skin).#tt#tummytuck

Hello! Thank you for your question! Surgical procedures for aesthetic
purposes, to improve appearance, are not covered by insurance.
Typically, these as well as complications resulting from such procedures
are the responsibility of the patient. Procedures that are meant to
correct functional issues and those which cause health-related issues
should be covered by your insurance as a medical necessity, with proper
examination and documentation. Some insurance plans have exclusion
criteria for certain procedures. Also, it is an obligation of the
surgeon not to attempt to authorize purely cosmetic procedures through
insurance.  This is an excellent opportunity and time to combine these procedures.  Facility and anesthesia times should begin upon completion of your hernia repair.  Discuss your issues and
complaints with a board-certified plastic surgeon to discuss these as
well as to examine and assist you in deciding which procedure(s) will be
the best for you. A discussion of the advantages and disadvantages will
take place along with the risks and benefits. Insurance companies will
vary on coverage and is always reasonable to discuss your issues with
your surgeon and primary care. It would behoove you to get as much
information as possible and even call your insurance yourself.
Certainly, pay in advance prior to your surgical procedure and options
such as financing are available if you qualify. Hope that this helps!
Best wishes!

Most insurance companies will cover the hernia repair procedure. You should start with consultation visit with surgeon of you choice to determine what type of hernia it is. The next step is to pre-certify the procedure with your insurance company. It can be done over the phone or some insurance companies will need a letter for predetermination of that benefit under your plan. Once the procedure is approved by your insurance you can proceed with surgery.

There are two issues here: 1) should the hernia be repaired at the same time and 2) will insurance cover a portion of the procedure. If the hernia is a true umbilical hernia, repairing at the same time as a full tummy tuck may result in compromise of the circulation of the umbilicus. Furthermore, these defects are increasingly being repaired laparascopically or with the use of mesh. In some instances, hospitals do not grant these privileges to plastic surgeons and a general surgeon may be the one who performs the repair and the one who bills for reimbrusement. In regards to reimbursement, most facilities have separate fees and will bill for these individually with pre-payment for the cosmetic portion