Would Like to Have Diastasis Recti Surgery Done Before End of This Year?

Diastasis recti is stretching of the abdominal wall fascia, usually from pregnancy or obesity. Repair of this is part of a properly-performed cosmetic abdominoplasty (tummy tuck).

Diastasis recti is NOT a ventral hernia. Ventral hernia repair is an insurance-reimbursible expense, but not a tummy tuck.

This is not a "coding" issue; coding it "appropriately" ensures it will be considered cosmetic and not covered, so stop looking for a surgeon who will commit insurance fraud. Save up and see an ABPS-certified plastic surgeon who is also an ASAPS member. Best wishes! Dr. Tholen

Unfortunately most insurance companies do not cover for the repair of diastasis recti. Reputable surgeons would not "code it" differently just to get it covered, which to some, would be considered fraud. Remember, if your surgeon is willing to lie to the insurance company, how do you know he/she wold not lie to you as well. The best plan would be to figure out a good way to save up the money. There are also good financing companies like CareCredit which might work for you. Good luck, and be careful.

There is no insurance coverage for a strictly cosmetic procedure ( normal tummy tuck). If you have a large apron hanging down with rashes and other symptoms, then you might get insurance to cover.

Insurance companies allow physicians to perform " medically necessary" procedures. No amount of convincing or manipulating of the system can change insurance companies stance. Hernia repairs are covered. Panniculectomy is sometimes covered. Cosmetic surgery (tummy tuck) is not.

Cheers

You should look at your local plastic surgery training program. Almost every program has an aesthetic clinic where residents learn how to do cosmetic surgery under the supervision of board certified plastic surgeons. Its a great way to get cosmetic surgery done safely and in an affordable way

GOOD LUCK!

Even 20 years ago with severe diastasis few if any patients could get covered. It is considered a normal result of childbirth just like droopy breasts. It is not a matter of "coding correctly", as some people will say or even the insurance company representative that wants to transfer blame to the physician. In other words if the physician coded cancer then it would be covered, but it is not cancer. Anyway, partial coverage does not save money contrary to popular belief. Even if insurance covered a partial amount, the costs of doing it at a facility that insurance would cover exceed the savings. Likewise hospitals will charge in full for the cosmetic portion, and adding that and the higher charges, copays and deductibles the total cost will be higher than a cosmetic abdominoplasty. But I have not seen an insurance company cover diastasis recti in over 25 years of practice.

You are asking for your plastic surgeon to commit fraud.  Most insurance companies will not cover diastasis recti and none cover an abdominoplasty.   There are no special codes that can be used to have it make it seem like medically necessary surgery.  Be happy that at least there may be some coverage for a portion of the procedure that your insurance company considers medically necessary.  

Hello,

You may be able to get the abdominal wall component of it covered under a ventral hernia code.  If a tummy tuck is done at the same time, insurance will only cover the hernia part.  If this happens the total tummy tuck cost will be reduced so that will be a benefit to you.  No matter what, the insurance company will not cover a tummy tuck. 

All the best,

Dr. Remus Repta

Insurance does not cover tummy tucks and few, if any, would cover the repair of a diastasis recti.  Even if the diastasis were covered, it takes a very small amount of the time involved in a tummy tuck and would not be that beneficial.