I have an umbilical hernia and diastasis recti. Will insurance cover the repair of both?

Question

3 months ago I had nausea and pain along the linea alba. My gallbladder was removed. I still have nausea and pain especially while sitting. Laying down helps relieve the pain and nausea. I have had blood work, endoscopy, colonoscopy, and 3 CTs (chest, abdomen, pelvis). The only thing that has been found is a small umbilical hernia and diastasis recti. I am 6' 1" and 183. My stomach looks distended and uncomfortable since the surgery. Will insurance cover the hernia and diastasis repair?

Raffy Karamanoukian, MD, FACS · Answer

Umbilical hernias are quite common and occur in the setting of a previous surgery, pregnancy, or diastasis recti. We treat umbilical hernias with or without correction of diastasis recti using a combination approach that corrects redundant skin in the lower abdomen and around the belly button. If there is a lot of skin, we would use a tummy tuck scar whereas smaller corrections can be performed using just the belly button incision which is well hidden inside your belly button.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Steven J. Rottman, MD, FACS · Answer

Thank you for your question.  While most insurance companies will cover an umbilical hernia repair, very few will pay for repair of rectus diastasis.  Please see a board certified plastic surgeon for an in-person examination to discuss the specific details of the procedures. Hope this helps!

Nelson Castillo, MD · Answer

Thank you for sharing your question and I am sorry to hear of your symptoms.  Most insurance companies will deem an umbilical hernia, especially one that is symptomatic, to be medically necessary and will cover the cost of repair.  A diastasis of the rectus muscle, however, is not considered medically necessary and insurance will not cover these associated costs.  If you would like both repaired, the hernia will help defray the costs of the diastasis repair, but be sure to see a board certified plastic surgeon in consultation.

Shirin Towfigh, MD · Answer

In my opinion, an umbilical hernia is best repaired if a concomitant Diastasis is also closed. Insurance will not cover the Diastasis closure portion, unfortunately.

Tariq Ahmad, MBBChir, FRCS(Plast) · Answer

It is certainly possible to repair both at the same sitting which obviously makes sense both physically and economically. Although some doctors may consider diastasis rectify to be a form of hernia it is not a true hernia so would not normally be  covered but you might be able to ask to check.

Alternatively you may be able to contribute a sum to cover the excess  for the additional procedure without having to fund the full cost.

Best of luck.

I have an umbilical hernia and diastasis recti. Will insurance cover the repair of both?

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I have an umbilical hernia and diastasis recti. Will insurance cover the repair of both?

Answers (9)

Answer: Umbilical Hernia within a Diastasis

Answer: Umbilical Hernia within a Diastasis

Answer: Simultaneous umbilical hernia and diastasis recti

Answer: Simultaneous umbilical hernia and diastasis recti

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Everything you need to know about Diastasis Recti Repair

Our mission is to create a world where every investment in modern beauty is Worth It.