I have a muscle split, how can I say its a hernia so I can have it tighten and get a tummy tuck so my insurance can pay for it?
Doctor Answers 9
Muscle separation, or diastasis recti is a common occurrence and correcting it is considered cosmetic- a standard component of full Abdominoplasty. Stating that you have a different, medical issue or a different surgery is not something your Plastic Surgeon will do for you. Unfortunately, many Insurance does not cover cosmetic, elective procedures.
All the best
Insurance coverage of a tummy tuck
A "muscle split", or widening of the space between the abdominal musculature is referred to as a rectus diastasis and it's repair is considered cosmetic, so insurance will not cover it. A hernia is a true hole in the abdominal wall and thus it may be medically indicated to fix. Knowingly labeling a diastasis as a hernia in order to get insurance coverage is fraud. Your doctor could lose their license, receive heavy fines, and possibly be jailed.
In order to get a qualified, ethical, and expert opinion on your surgical options and expectations, always have an in-person consultation with a plastic surgeon certified by the American Board of Plastic Surgery.
Best of luck,
Keith M. Blechman, MD
New York, NY
Simply put...you cannot. That would be considered insurance fraud by both you and your surgeon. Repair of a rectus diastasis is considered cosmetic and not covered by insurance under any circumstance. The diastasis is repaired as part of the tummy tuck procedure. Hope this helps. Best wishes!
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Tummy tucks including the diastasic recti ( or muscle separation) are cosmetic procedures and not covered by insurance. Sorry.
Insurance company to pay for it??
Your request is disingenuous and will not be attempted by any board certified plastic surgeon or accepted by a health insurance company. See a general surgeon to discuss your care.
If by "split" you mean rectus diastasis, and not hernia, insurance will not cover it. It would be best to see a general surgeon to get a diagnosis of hernia. If you go to a plastic surgeon, the insurance company will not believe what we say as it is seen as "the fox guarding the gen house". Once a general surgeon has given you a diagnosis of hernia and documented that, go see a board-certified plastic surgeon about having that fixed at the same time as an abdominoplasty, And be prepared to pay for the abdominoplasty. Best of luck to you.
Insurance coverage for tummy tuck
The insurance companies are way ahead of you. Diastasis repair is not covered. A hernia is one of the lowest paying procedures, only several hundred dollars. They understand that, as plastic surgeons, we do not repair hernias. Obviously, no one is going to accept a pittance and commit insurance fraud so you can have a free procedure that otherwise costs over $10,000. The hospitals are also aware that a hernia repair can take 15 minutes whereas the tummy tuck will be a three hour procedure; they will not be paid for the excess OR time.
Insurance Coverage for Abdominal Wall Hernia
Many healthcare companies cover abdominal wall hernias. The diagnosis and procedure need to be pre-certified to ascertain coverage. The co-pay, deductible, and co- insurance vary greatly and are the patient's responsibility. Best wishes!
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