I have an umbilical hernia and severe rectus diastasis, can I get my Tummy Tuck at least partially covered by insurance?

I have an umbilical hernia and severe rectus diastasis that has resulted in a ruptured disc and herniated disc in my low back. I understand that a tummy tuck would repair both of these. My insurance (primary as well as supplemental) would cover both repairs even if I had a cosmetic procedure done at the same time as long as it is coded correctly. Any suggestions on finding the right doctor who will work with me on this? Anything specific I need to ask/say to maximize my coverage?

Doctor Answers 10

Umbilical hernia repair and tummy tuck

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Yes, insurance companies will pay for umbilical hernia repair and many plastic surgeons accept health insurance.  However, it is probably going to make little difference in your overall cost of surgery and if you have a high copay plan, it is conceivable that involving your insurance company could cost you more.  Discuss your options with your surgeon's coordinator.

Boston Plastic Surgeon

Insurance coverage for umbilical hernia

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Typically your insurance company will pay $200 for an umbilical hernia repair.  You can submit this after the fact to insurance company, your PS can help you with the codes. Expecting more than that will leave you disappointed. That is why PS don't take insurance.  

Robert Kearney, MD, FACS
La Jolla Plastic Surgeon
5.0 out of 5 stars 32 reviews

I have an umbilical hernia and severe rectus diastasis, can I get my Tummy Tuck at least partially covered by insurance?

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   I would not even worry about getting the insurance involved as the rates of reimbursement to the surgeon are abysmal and you will have to pay deductibles and copays.  I will perform the hernia repair and diastasis correction as a part of the tummy tuck.

Kenneth Hughes, MD

Los Angeles, CA

Find an surgeon accepting of your insurance

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either as a contracted provider or out of network provider and a surgeon who is willing to accept the insurance payment as part of your procedure.  Due to the extremely poor reimbursement from insurance companies, when my patients are faced with this scenario, my cosmetic fee is simply added to the costs of the insurance portion.  When you throw in your co-pays and deductibles, its often better to find a surgeon who will simply repair your hernia and diastasis as part of your cosmetic procedure, leaving insurance completely out of it.  In my practice, I  repair umbilical hernias if patients are willing to give up their belly button.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Hernia, Diastasis, Tummy tuck with Insurance coverage?

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Insurance companies will cover the repair of an umbilical hernia. They have pre-determined rates and providers (typically general surgeons) in their network. The first issue is whether or not your plastic surgeon is in-network or out of network. The next question is to find out if your insurance plans even covers out of network if your plastic surgeon does not accept the insurance plan. As far as the diastasis is concerned, I have never had the experience or known anyone who has had that service covered by insurance. Your issue in your low bac and herniated disk are unrelated to the hernia and likely to the diastasis as well. The tummy tuck is purely a cosmetic procedure and no part of it will be covered by insurance. In some circumstances, if your surgeon does the surgery in an in-network surgical facility then a part of the anesthesia may  be covered. My experience is that is likely minimal but it is very insurance plan based. Hope this information helps!

Tummy tuck and umbilical hernia coverage by insurance

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Some insurance companies will contribute something for an umbilical hernia repair.  

Other insurance companies do not cover umbilical hernia repair if it is done at the same time as an abdominoplasty, no matter how severe the umbilical hernia is or what problems it is causing.

Your surgeon can inquire with the insurance company and the exact amounts can usually be determined in advance.

However, insurance companies sometimes reverse themselves and decide not to cover after the fact.  Successful patients often have to appeal several times and contact the insurance company in order to have their hernia repairs covered.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

I have an umbilical hernia and severe rectus diastasis

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Umbilical hernia has its own code that is universally used by all surgeons and is usually covered by insurance at rates they determine. The surgeon has no creativity in this. No part of the abdominoplasty has any coverage from insurance companies. Many surgeons do not accept insurance coverage if the rates are too low. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

I have an umbilical hernia and severe rectus diastasis, can I get my Tummy Tuck at least partially covered by insurance?

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Ultimately the only part that would be covered by insurance would be the repair of the hernia, the rest is cosmetic and would have to be paid for as such.  Insurance companies have very strict rules about coverage and although cosmetic and non-cosmetic surgeries can be combined, they make us break down the fees.  When in the operating room we must note the start and end time of the of the cosmetic and the medically necessary portions of the procedures so that they can divide up the surgeon fees, operating room/facility fees, and anesthesia fees into what they pay and what you pay. Depending on the size of the hernia you may want to separate them out into 2 procedures anyway which can be discussed during a consultation with a plastic surgeon.  In our office, we typically will perform both at the same time if the hernia is relatively small.

Megan Jack, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 15 reviews

Repair of an umbilical hernia and diastasis during an abdominoplasty may be covered by insurance.

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You should visit a board-certified plastic surgeon who can inquire on your behalf whether or not insurance will cover any part of the abdominoplasty. There is no standard insurance criteria for what is and what is not covered.

I have an umbilical hernia and severe rectus diastasis, can I get my Tummy Tuck at least partially covered by insurance?

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Thank you for your question..

Search for a Board Certified Plastic Surgeon with privilege in a hospital any procedure done with insurance has to be done in a hospital. 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.