Insurance coverage: general doctor for hernia/diastasis and plastic surgeon for skin etc. (photos)

I just met with a general surgeon regarding my umbilical hernia and severe DR. She will refer to the DR as a "large ventral hernia" for insurance purposes to have the muscle repair covered as she will do this as part of the ventral hernia repair. She said I may want to have a plastic (in her practice) to "close up" and take care of the skin etc. Does this sound like a good plan? I have had 3 large babies and 3 c sections, my diastasis was repaired on the bottom by my OB. Photo attached.

Doctor Answers 2

Insurance?

Unless your general surgeon truly feels that this is a ventral hernia they are putting themself at risk with regard to coding it as a hernia. The appearance of your abdomen from the side view is consistent with having the lower portion of your rectus diastasis repaired in the past. 

 That said, if this is treated and repaired as a ventral hernia then certainly a plastic surgeon could do the remaining portion as suggested by your general surgeon.  I would tend to charge a patient less if I do not have to do the muscle work, so you might inquire with regard to that at your plastic surgeons office.   Though be aware that many plastic surgeons may not change their pricing based on whether or not they repair the muscle or not. Best of luck to you. 


Annapolis Plastic Surgeon
5.0 out of 5 stars 18 reviews

Diastasis and hernia repair

I would caution you because insurance no longer covers diastasis. Faking a diagnosis is fraud and insurance companies have targeted this coding.  Many require testing to establish the hernia. A plastic surgeon does much more than simply close a wound. For example, a hernia repair can take 20 minutes whereas an abdominoplasty can be a three hour procedure. 

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 40 reviews

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