Diastasis Recti Repair - Why Won't Insurance Cover It If a Tummy Tuck is Involved?

Excellent points. In my experience, repair of a wide diastasis, often the result of multiple births and perhaps baseline abdominal wall weakness, consistently offers functional benefit when the patient is suffering. Not only can the patient perform core exercises better, but I've seen urinary incontinence, back pain, irritable bowel syndrome, posture, and other medical problems significantly improve or completely correct following tummy tuck. In such cases, I usually reinforce the repair with absorbable mesh, P4HB across the abdomen and plication.

That being said, insurance companies are businesses, and they are in business for profit. They'll not cover anything they can get out of covering, and what they pay for, they pay as little as possible. Insurance companies have developed high tech, intensely studied, managed, and executed institutional methods to minimize, avoid, defer, deny, delay, payment, and even to defraud providers without accountability.

If you believe yours should be covered, you may get it covered, but it will likely take a concerted campaign to do so.

U fortunately in the past many plastic surgeons have used diastasis the same as they would hernia and used this to justify a tummy tuck. As a result insurance companies will rarely cover the procedure no matter what and especially if requested by a plastic surgeon. On the other hand many plastic surgeons don’t want to perform a tummy tuck only to get very poor reimbursement from the insurance company.