How to get diastasis recti covered by insurance? (Photos)

Question

I am 23, and 120 pounds. I have been through one pregnancy 5 years ago. I get severely bloated when I eat, it’s hard for me to move and breathe after I eat. Sometimes it’s so difficult for me to breathe after I eat that I feel like I have to force myself to throw up to be able to breathe. The pictures I am providing are on the same day, after eating half of a sandwich, and 2 bottles of water. Is there any way to get this covered by insurance? It’s not for cosmetic reasons.

Leland Deane, MD, FACS · Answer

The separation (and bowing out) of the rectus muscles after pregnancies, is an almost universal phenomenon. Also, there may be tears in the oblique muscle fascia as well and these can't be detected until surgery. As others have said, the correction of these problems is not covered under insurance plans. In my thirty years of practice, I have gotten one patient covered, and that was after she had twins as well as triplets and had a defect about twenty centimeters wide.

By the way , there are many problems which improve after abdominoplasty (at least the high tension type of repair) that are being documented, like urinary/bladder issues and back pain. The point is that there may be insurance coverage in the future, but no at present.

Hope this helps.

Daniel Careaga, MD · Answer

Insurance companies consider a diastasis recti to be a cosmetic deformity. As such, I am not aware of a single insurance company that will cover repair.

Rady Rahban, MD, FACS · Answer

Hello,

You bring up a great question. Unfortunately, insurance companies don't recognize DR as more than a vanity issue hence, don't typically cover it. However, for many it truly is more than a vanity issue and has contributed to pain and discomfort. Correcting the DR has alleviated most of these symptoms for a majority of my patients. It's a shame it's not covered.

Kenneth Hughes, MD · Answer

Diastasis recti repair is typically part of a TT which is considered cosmetic by insurance companies. Hernia repair with a TT is typically is covered by medical insurance (though the reimbursement is pathetic). You will be responsible for the deductible.

Daniel Barrett, MD · Answer

Dear Dynamic451471
generally speaking, diastasis recti repair is considered an elective procedure and insurance won't cover it. 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

Ronald J. Edelson, MD · Answer

Very difficult to get covered. The problem is that plastic surgeons in the psst abused rectus diastasis by calling it a hernia, which it is not. Insurance companies are now wise to this ploy and recognizing it right away. You may get lucky and if you want to try you can. I doubt you will be successful.

Darryl J. Blinski, MD · Answer

Unfortunately in these days heath insurance restricts the coverage for diastasis recti following pregnancy. Best to call your health insurance carrier to open a file for coverage and or ask if this is a covered benefit.  Then you need to find a boarded PS whom is willing to accept the coverage amounts in reimbursements (which are quite low!). Plus there will also be a cosmetic component to the fee in the $8,000-$10,000 ranges. So you trying to obtain minimal coverage will take time and you still will have to pay out of pocket.

Kristen Aliano Messina, MD · Answer

In general, diastasis recti repair is typically not covered by insurance. Many/most insurance companies consider it to be cosmetic. Bloating can be caused by diastasis, but it may also be caused by other medical conditions; it is hard to see the diastasis from the photos. I would recommend that you see your primary care doctor to rule out other causes of bloating. If you do have a diastasis that you are interested in repairing, I recommend that you seek care with a fully-trained plastic surgeon in your area for proper evaluation, discussion of treatment options, and cost.

How to get diastasis recti covered by insurance? (Photos)

Answers (8)

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