Is there a doc who accepts Aetna Innovation Health willing to repair this hernia with muscle repair of abdomen? (photo)

I have a history of heartburn and acid reflux. Doc said hernia may contribute to the problem. Aetna considers repair of a true incisional or ventral hernia medically necessary. Aetna considers repair of a diastasis recti, defined as a thinning out of the anterior abdominal wall fascia, not medically necessary because, according to the clinical literature, it does not represent a "true" hernia and is of no clinical significance. What Aetna policy mean?

Doctor Answers 5

Tummy Tuck and Hernia Repair

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question about tummy tuck.

You or your plastic surgeon will need to contact Aetna directly and apply for predetermination and precertification for your specific case.

A hernia may be covered.  A tummy tuck will not be likely be covered.

To be sure, see two or more experienced, board-certified Plastic Surgeons in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have tummy tuck or body contouring surgery.

I hope this helps.

Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

Heartburn are reflux are not caused by incisional or ventral hernias.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Your statement that "doc said that hernia may contribute to the problem" needs clarification. He may have been talking about a hiatal hernia, which is entirely different from ventral or incisional  hernia. In fact, repair of abdominal wall hernias, or cosmetic muscle plication as performed during tummy tuck, BOTH may make the symptoms of heartburn or acid reflux WORSE, as your belly just got tightened, and your intra-abdominal organs, mesentery, and omentum didn't get smaller. This increases intra-abdominal pressure, and can indeed cause increased reflux problems.

I'd advise weight loss first, NOT tummy tuck surgery, and see if your reflux and heartburn are improved. You should also see a gastroenterologist, as chronic reflux can lead to Barrett's esophagus and esophageal cancer if left untreated. Yes, heartburn can lead to esophagus or stomach cancer! Repair of hiatal hernia is often surgical, and totally unrelated to tummy tuck surgery or abdominal wall diastasis, hernias, or muscle repair.

What this means is that you have medical issues (probably hiatal hernia, causing reflux and heartburn, appropriate for coverage for medications or intra-abdominal surgery needed to correct these issues), and that your desire for a tummy tuck is entirely cosmetic and has nothing to do with insurance coverage, even with a diastasis.

You cannot get your insurance to cover tummy tuck surgery. But you really knew that, didn't you?

You should consider these recommendations:
  1. Lose weight and see what that does for your heartburn and acid reflux
  2. See a gastroenterologist for upper GI endoscopy
  3. Proceed with any hiatal hernia surgery deemed necessary and appropriate for your symptoms or overall health. Medications can sometimes avoid surgery.
  4. When all is well and your heartburn and reflux are gone (as good as possible), then consider elective cosmetic tummy tuck for improved appearance, and understand that increased tightness of your abdomen may cause return of your symptoms (or worsening).
I hope this helps. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Hernia Repair

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question.  If one of your doctors has told you that you have a hernia, corrective surgery is a covered expense under your insurance plan.  If you simply have separation of your stomach muscles, this is deemed a cosmetic procedure and you would be responsible for the costs of surgery.  Hope this helps.

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 80 reviews

Insurance does not pay for diastasis repair

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Diastasis is not a defect or hole in the abdominal wall and poses not medical threat to your health.  Diastasis produces a "roundness" to your abdomen that is cosmetically unpleasing.  Insurance companies 


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Insurance will not cover cosmetic cases and if you have a hernia fixing it does not entail liposuction or removing excess skin.  If you are considering a tummy tuck then it would be best to be evaluated by a PS.  You also have intra-abdominal fat that you will need to lose with diet and exercise if you want to achieve a flat tummy with a tummy tuck.

Anh Lee, MD
El Paso Plastic Surgeon
4.9 out of 5 stars 42 reviews

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.