I have hernias in the abdominal muscles. Is it reasonable to have a plastic surgeon perform the surgery and also do a Tummy Tuck at the same time? Since the hernia surgery is medically needed, would insurance pay for part of the costs?
Will Insurance Pay for Hernia Surgery with Tummy Tuck?
Doctor Answers 9
Yes hernia surgery is usually covered by the insurance
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.
Insurance coverage for hernia surgery during a tummy tuck
Tummy tucks are a very popular and effective way to contour the abdomen and tighten your waist. In our practice, it is routine to perform a tight tuck at the same time as a different surgical procedures such as a hernia repair. If you have a small hernia repair, your plastic surgeon may elect to fix the hernia themselves. However, if you have a large hernia or a hernia that requires a mesh repair, a general surgeon may work in conjunction with your plastic surgeon. In either situation, it is possible to obtain pre-authorization for the hernia repair before your tummy tuck. This is advantageous as the insurance company may also cover a portion of your anesthesia and facility costs as well.
To learn more about tummy tucks, see photos, and help you decide which one is best for you, please visit us at the link below:
Insurance coverage for hernia repair and tummy tuck
If you truly have a hernia like an inguinal or umbilical, then your insurance should cover that part of your surgery. If you are calling a diastasis or weakness in the muscle fascia a hernia, they will not cover that.
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Paying for a tummy tuck and hernia repair - insurance can help
If you have abdominal hernias, your insurance should cover a repair. If the repair is done at the same time as an abdominoplasty, you can save part of the costs since some time of surgery will be paid for by the insurance company.
In cases where there is chronic inflammation or dermatitis under hanging skin, the insurance may cover removal of excess skin as well (panniculectomy). You should discuss this during your consultation with plastic surgeons.
In many cases a plastic surgeon will work together with a general surgeon, which may make insurance coverage easier.
Insurance may only cover hernia repair
Often times they will pay for the portion of the procedure that involves the hernia repair, but rarely will they pay for a cosmetic procedure, or any of the operating rooom, anesthesia fees that would not normally be associated with the hernia repair (i.e. the cosmetic procedures).
In my experience, the savings gained by having insurance companies cover a portion of the procedure have been modest at best, and as always, your usual deductibles, co-pays and other isues will still apply.
Insurance may not always pay for hernia surgery
First you have to determine that it is a true hernia and not just a weakness or diastasis (separation). Incidental hernias and symptomatic hernias are different. Insurance plans are different. If you have a true hernia that is symptomatic, chances are your insurance company may cover part of the costs.
However, you should review all your costs since sometimes the additional cost of doing a cosmetic procedure in a facility that may accept insurance payment for the hernia will be more expensive than doing the entire procedure in a facility dedicated to cosmetic surgery that does not accept your insurance.
Also, do not do a tummy tuck just because you have to repair a hernia and because insurance might cover some of your costs. Separately evaluate the appropriateness of repairing your hernia and the appropriateness of doing a tummy tuck.
Reasonable to have hernia repair with Tummy Tuck
Yes, a plastic surgeon can do the hernia repair if they feel comfortable doing so. Insurance should cover the hernia repair cost and if you have skin irritation under your excess skin, they might cover the cost of the skin excision as well.
Will insurance pay for hernia surgery with tummy tuck?
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!
Hernia and Tummy Tuck: Insurance considerations
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
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.