I've had 3 kids and am in my 3rd hernia. I have yet to have this one repaired because of the cost. I have a severe abdominal wall separation. If the muscle repair would prevent future hernias why won't the insurance pay for it? How do I appeal successfully?
August 10, 2014
Answer: Hernia versus diastasis recti Insurance companies do not cover diastasis recti (separation of abdominal muscles) but will cover true hernias like an umbilical hernia repair (belly button). A true hernia is a defect (a hole) of the abdominal wall, which can be dangerous if an intestine gets stuck and the blood supply is compromised. This can lead to the intestine dying and a complicated surgical and medical course. Diastasis recti does not have this risk since it is a speration of the muscle and not a true hole in the abdominal wall, thus the insurance companies do not deem it a medical necessity.
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August 10, 2014
Answer: Hernia versus diastasis recti Insurance companies do not cover diastasis recti (separation of abdominal muscles) but will cover true hernias like an umbilical hernia repair (belly button). A true hernia is a defect (a hole) of the abdominal wall, which can be dangerous if an intestine gets stuck and the blood supply is compromised. This can lead to the intestine dying and a complicated surgical and medical course. Diastasis recti does not have this risk since it is a speration of the muscle and not a true hole in the abdominal wall, thus the insurance companies do not deem it a medical necessity.
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August 18, 2014
Answer: Muscle repair and hernia repair. Why won't insurance cover both? Thank you for the question! You mentioned that you are on your third hernia. Have you had repairs in the past? If you need a hernia repair and you have separation of the abdoinal musculature, you can have both repaired simultaneously. However, insurance does not cover tightening of the musculature which is cosmetic. Best of luck.- Dr. Mussman
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August 18, 2014
Answer: Muscle repair and hernia repair. Why won't insurance cover both? Thank you for the question! You mentioned that you are on your third hernia. Have you had repairs in the past? If you need a hernia repair and you have separation of the abdoinal musculature, you can have both repaired simultaneously. However, insurance does not cover tightening of the musculature which is cosmetic. Best of luck.- Dr. Mussman
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