Will Insurance Pay for Diastasis Recti?

Question

I had very large twins in 2010. 16 lbs of babies, 4 lb placenta and 1000mls of fluid. I was stretched to the MAX. Now I have this bulge which is diastasis and whenever I exercise my abdomen it seems painful and can it also cause back pain? bc i'm def experiencing that too. Just want to find out if there are cases in which insurance agencies pay for this. A friend of mine had a mommy makeover and her surgeon is going to try to send that portion in bc it was medically necessary, i think mine is too

Aldo Guerra, MD · Answer

Hi there. Thanks for your question. I am not aware of insurance covering a diastasis repair as it is mostly a cosmetic issue.

Joshua Cooper, MD, FACS · Answer

This question is commonly asked, and unfortunately, in my experience, insurance companies never cover repair of diastasis.
	
		Definitely meet with a board certified plastic surgeon to make sure that you might not have a hernia, because insurance companies may cover the hernia repair.
	
		Best of luck to you!

Joseph L. Grzeskiewicz, MD, FACS · Answer

There is an ICD-9 diagnosis code and a CPT code for diastasis and repair respectively, and therefore where there's a will there's a way. I would say that it depends upon your insurance company and the person there who is reviewing claims or preauthorizations as well as your doctor's case based upon the medical necessity of the procedure in your case. If you think you have a case go ahead and submit for preauthorization and see what happens.

Tom J. Pousti, MD · Answer

I am not aware of an occasion (in my practice) where an insurance company has agreed to cover the procedure.

	 Best wishes.

Samir Shureih, MD · Answer

Diasthesis Recti repair is not covered by insurance. It is not a medical disease. It is for improving the look of the abdomen.

Will Insurance Pay for Diastasis Recti?

Answers (5)