When you have Diastasis Recti is it covered by insurance?

Dear shilleen jones,
Diastasis recti repair is an elective procedure and it is not covered by insurance. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Thank you for asking this question.  I wish I could say it is a covered procedure, as for many people the symptoms can be debilitating.  However, up to date, it is not seen as a medically necessary procedure.  Specifically, there isn't a specific code for diastasis recti repair like there is for example a hernia repair. However, it's no uncommon to have a hernia coexist with diastasis recti.  The hernia portion is generally a covered procedure and can be submitted for reimbursement.

No.  If you have an umbilical hernia which can be repaired in most instances at the time of the tummy tuck with diastasis recti repair, the tummy tuck will not be covered by insurance, but hernia repair typically is (though the reimbursement is pathetic). You will be responsible for the deductible.

Diastasis recti repair is part of an abdominoplasty and not covered by medical insurance.  True abdominal or ventral hernias should be covered by insurance companies- usually treated by general surgeons, not plastic surgeons.

Diastasis rectus is not considered a medical issue covered by insurance to correct.  Almost all insurances that I have seen make a specific point to note that it is not covered. 

Thank you for your question. Unfortunately, unless you have a true hernia it is not covered by insurance. A true hernia has a complete separation of the muscles and fascial layer so only the fat and skin are covering the defect. This is a need for surgical repair. Diastasis is a weakness but the fascia is still intact.

Being in practice for over 30 years, I remember the good old days when diastasis repair was covered. Insurance companies are now in the business of saying no to patients and yes to shareholders.  Diastasis has not been covered for the past 10 years on that basis, even though many patients complain of associated pain when lifting. Fidelis does not cover diastasis.