Is hernia repair covered by insurance if it's done during a tummy tuck procedure?

Is hernia repair covered by insurance if it's done during a tummy tuck procedure?

Doctor Answers 10

Hernia repair with tummy tuck

It is not uncommon to have a hernia repair at the same time as a tummy tuck depending on the type and size of the hernia.  Your surgeon will have to fully assess you and the hernia.  He/she will then submit your case to your insurance for approval/denial.  I recommend consulting with one or more board certified plastic surgeons who are in-network with your insurance.  If your surgeon is out-of-network, you will likely have higher charges for the hernia repair through your insurance.  Hope this helps.  Best wishes!

Hernia repair and tummy tuck

If you have a real hernia like an umbilical or inguinal hernia, then that part would be covered. A tummy tuck and anesthesia for the tummy tuck, and tummy tuck facility fee will not be covered.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Insurance should cover the hernia repair

Thank you for your question. I perform a lot of tummy tucks and it is relatively common to find a either an umbilical hernia or a ventral hernia in the area an old scar at the time of examination.  The hernia repair is generally covered by insurance as long as it is pre-approved.  If you have a high deductible that has not been reached, it may be cheaper for you to find out from your surgeon how much he/she would charge for the repair and not go through insurance.  If you do go through insurance, there will be anesthesia, facility and surgeon fees that could be much more than you want to spend. It is, however, to get the hernia fixed at the same time as having a tummy tuck. 

James McMahan, MD
Columbus Plastic Surgeon
4.8 out of 5 stars 35 reviews

Hernia Repair Coverage during a Tummy Tuck

There is a fundamental difference between muscle separation associated with pregnancy or Diastasis which is seen in every women who carries a child to full term and a hernia, where intraabdominal content is pushed out and forward through a weak point (such as the belly button) and may be at risk of being twisted or losing its blood supply. 

Most insurance companies would "cover" hernia repairs IF you and your Plastic surgeon request (sometimes repeatedly) for it. But it requires calls and letters to the insurance before the repair. Asking the insurers to pay for it after the surgery is a gamble: sometimes the insurers pay but often they do not. 

Lastly, misrepresenting a muscle separation as a hernia for insurance payment of a cosmetic tummy tuck is fraud. Most ethical Plastic surgeon would refuse to engage in it. 


Peter A. Aldea, MD


Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 102 reviews

Is hernia repair covered by insurance if its done during a TT procedure?

Thank you for sharing your question.  If your insurance company approves your hernia repair you can have this expense covered under your plan at the time of your tummy tuck.  It would be important to completely understand the costs associated with your insurance to determine if this will be of benefit to you.  Your surgeon's office will best be able to assist you. 

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 43 reviews

Hernia repair during tummy tuck surgery

Usually, hernia repair is covered by insurance even if it is performed during the tummy tuck operation. Key points: get a preauthorization from your insurance company (your plastic surgeon's staff should conduct this service for you). Expect that the portion of the operative costs for anesthesia and the facility where your operation is performed will "carve out" the portion of the fee that is functional (hernia repair) and that portion which is cosmetic. If the deductible for the hernia repair charge is high as many are now with health insurance under the "Affordable" Care act, then it may be less expensive to simply pay for the hernia repair out of pocket. The advantage to using insurance for the functional part is that in the event of complications or any situation that requires additional charges after operation, insurance is liely to cover these expenses, while if your operation is performed for strictly cosmetic purposes, insurance is not likely to cover expenses for managing complications.

Tad Grenga, MD, FACS
Norfolk Plastic Surgeon
5.0 out of 5 stars 11 reviews

Is hernia repair covered by insurance if it's done during a tummy tuck procedure?

Thank you for the question.

In my opinion, the best time to repair an umbilical hernia (or other types of ventral abdominal wall hernias) is at the same time that you are having a tummy tuck done. At that time, the hernia is easily  exposed and repaired,  negating the need for further surgery. Care must be taken during the performanceof  umbilical hernia repair to avoid compromise of blood flow to the overlying skin.


Whether or not your insurance company will cover the hernia repair procedure is a question best address to your insurance company, given the policies will vary.


 Best wishes.

Hernia repair usually covered by insurance

Yes, if you have a real hernia, then the repair is typically covered by your insurance company and the procedure can be performed at the same time as your tummy tuck which can help reduce some of your costs. Schedule an appointment with a board certified plastic surgeon in your area to be assessed in person and discuss. You might also want to call your insurance company to check on your policy.

Kindly,

Kouros Azar

Kouros Azar, MD
Thousand Oaks Plastic Surgeon
4.8 out of 5 stars 21 reviews

Hernia repair during TT

Repair of a hernia is common during a tummy tuck. If it's a small umbilical hernia, often your surgeon will just repair this as part of your tummy tuck, so applying for insurance isn't really useful. However, if it's a bigger hernia or your surgeon is charging more for hernia repair, then applying for insurance coverage can be worth it. 

Best wishes,

Dr. Blagg

 Austin, TX

Yes

It is very common to have an umbilical hernia repaired at the same time as a tummy tuck and insurance companies typically pick up the cost.  

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.