Are umbilical hernia repairs covered by insurance? Is there anything that can correct diastasis recti besides a TT? (Photo)

Question

Since I gave birth to my twin girls in January 2017, I can’t tell if I would need anything other than a hernia repair for my stomach- my core feels very different than it used to, but the few doctors I’ve spoken to say I just need a umbilical hernia repair. I’ve read that this surgery can be covered by insurance. I’m not even sure who I need to see about it- a general practitioner to refer me to a plastic surgeon, or got straight to a plastic surgeon? (We’ll be switching insurance this month)

Daniel Barrett, MD · Answer

Dear kelseydubya,in most cases umbilical hernia is covered by insurance. A small umbilical hernia is something that can be fixed during a full tummy tuck procedure. I routinely repair these during my tummy tuck procedures. Not everyone feels comfortably repairing these however. I would have to examine you to be certain. Make sure to follow up with a board-certified plastic surgeon.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Joubin Gabbay, MD · Answer

Most insurance companies will cover the cost of an umbilical hernia repair. This is a procedure that is performed very commonly with tummy tucks. Also, you do not need a full tummy tuck to repair a dye stasis wreck type. There are several options available. I would recommend having a consultation with an experienced plastic surgeon to go over your options.It's critical that you seek the advice of a surgeon who is certified by the American Board of Plastic Surgery and has extensive experience with tummy tucks.
I wish you the best,
Dr. Gabbay.

Scott C. Sattler, MD, FACS · Answer

If you have an umbilical hernia that is bothering you, its reasonable to get it repaired. We often repair umbilical hernias at the time of abdominoplasty surgery. A plastic surgeon should be able to provide some guidance in your particular situation.

Tim Sayed, MD, MBA, FACS · Answer

Exam is required to diagnose an umbilical hernia. They are commonly covered by insurance and umbilical hernia repair is done routinely by general surgeons. Plastic surgeons also commonly perform these as part of a tummy tuck (cosmetic procedure) or more complex abdominal wall reconstruction (reconstructive). If you are combining with a tummy tuck, the surgeon and facility MAY accept insurance for the umbilical hernia portion of the procedure with the remainder of the aesthetic tummy tuck operative time paid out-of-pocket. Diastasis recti itself is a common byproduct of pregnancy and is routinely addressed in a tummy tuck as well; repair of isolated diastasis as a complaint is usually NOT covered by insurance in the absence of a true hernia, even though the TECHNIQUES to repair diastasis share many things in common with simple hernia repairs. Best bet is to get a referral to a general surgeon to examine you and determine if you have a hernia. If so, and you want that addressed by itself, the general surgeon can repair it. If instead you want more comprehensive treatment of your abdomen, consider a plastic surgery consultation.

Michael Zarrabi, MD · Answer

The umbilical hernia is usually covered by your insurance. Other than surgery, there is very little that can "correct" a diastasis. You should also consider physical therapy to strengthen your core and this can often improve the diastasis.  If you have a significant separation then a tummy tuck may be your best option.  Consult with a plastic surgeon and get a couple of opinions. Most plastic surgeon will feel comfortable taking care of both.

Milind K. Ambe, MD · Answer

Thank you for your question and photo.  Whether your insurance covers this procedure depends on many factors (who the doctor is, where the procedure is performed, if the surgeon is in or out of network). So I recommend contacting your insurance company to see which general surgeon is in your network.  Likely your Ob/Gynecologist also can provide local recommendations.  If you do not wish for an abdominoplasty then I think a general surgeon would be your best person to contact.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the question and your diastasis and hernia can be repaired without an abdominoplasty but whether it would be covered by insurance will require prior authorization.  So go on some consultations and be evaluated and start the authorization process Dr Corbin

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