Will insurance cover a scar revision for gastroschisis?

Question

I'm 18 and was born with gastroschisis and a scar that's almost tear drop shapes and rather deep. I have been looking into getting a revision or some kind of umbilicalplasty to give me something reminiscent of a "normal" looking belly button, what are the chances that insurance would cover, if any, of the costs?

Praful Ramineni, MD · Answer

I've definitely had success in the past obtaining insurance coverage for an umbilicoplasty given that this is an abdominal wall deformity reconstruction due to a medical issue. It's best to discuss with your PS and depending on the insurance, he/she may be able to obtain a preauthorization/predetermination for the procedure.

Pravin Reddy, MD · Answer

Thank you for the question.
Since gastroschisis is a congenital condition, third-party payers are expected to cover any treatments associated with the condition.  If you are experiencing any symptoms associated with the scar, this would help in securing authorization for the revision procedure.
You may have to undergo staged reconstruction of the scar with the possible use of tissue expanders.  I would consult the original surgeon or the hospital where the original treatment was administered.  
I hope this answer is helpful.

Brian Citro, MD · Answer

Health care and insurance is complicated. Most insurances will not cover cosmetic surgery and your problem would likely be considered cosmetic. The best way to get it covered is if the tissue is causing a problem (skin rashes, infections, pain, etc.). I recommend you obtain a consultation with a plastic surgeon who specializes in reconstruction of damaged tissue. Best of luck.

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