Is Rectus Diastasis Repair Ever Medically Necessary & Covered by Insurance?

Question

I have rectus diastasis as well as 2 hernias from a twin pregnancy. I have visited 1 gen surgeon & 1 plastic surgeon. I have been told the hernias would be covered under my insurance but the rectus diastasis wouldn't. Is there anyway I can get it covered? I was also told that having the gen surgeon present repairing the hernias wouldn't cut costs(hospital fees, anestesia) on the other half of my surgery with the plastic surgeon ( "b/c he runs under a different clock")... Is that true?

Sanjay Lalla, MD, FACS · Answer

I agree that rectus diastasis is not covered. However we repair the hernia in addition to the rectus diastasis so it is possible to save a small amount of money since we perform both procedures. Good luck

J. Jason Wendel, MD, FACS · Answer

Thank you for your question.

	Insurance usually covers hernia repair but not diastasis recti. Both can be repaired during a tummy tuck.

	Check with your board-certified plastic surgeon to discuss specific details.

	Best wishes.

David Shafer, MD, FACS · Answer

Yes, that is true.  Your insurance company may cover your hernia repair but will not cover the rectus diastasis repair.  If you choose to have both procedures, then the hospital will set a clock and charge your insurance company for the OR and anesthesia time required for the hernia repair but not for any non-covered procedures you have at the same time.  There really is no way to game the system and it sounds like your plastic surgeon is being honest with you.

	 

	Good luck.

Stephen M. Chen, MD · Answer

Your situation is not uncommon. Hernia is a covered insurance procedure, diastasis repair is not. Both can be fixed at the time of abdominoplasty. The insurance covers the hernia repair and an overnight stay, other than that the rest is out of pocket for the abdominoplasty.

Curtis Wong, MD · Answer

can be tricky in most facilities.  You will need to explore this further with where you are planning to have your surgery.  In addition, the surgeon doing the muscle tightening is not going to be paid by the insurance company and in reality, he shouldn't. 

	If you want to keep this 'clean' when considering billing and co-pays, you can have your hernias repaired first then come back at another time and have your cosmetic tummy work done.

	In summary, diastasis is NOT covered by insurances and you should pay extra if having a cosmetic procedure done at the same time.  We have learned from our transgressions in the past.

Robert L. Kraft, MD, FACS · Answer

I agree.  Insurance companies in NY stopped paying for repair of diastasis several years ago as part of their efforts not to pay claims.  The hospital does start the clock again when the plastic surgeon comes in and, unfotunately, it becomes more expensive to combine the two procedures than to have them separately.  Of course, the abdominoplasty part of an operation is cosmetic and not covered.

George J. Beraka, MD (retired) · Answer

Hi.

	This is a common situation.  The diastasis repair is cosmetic surgery and you will have to pay for that directly.

TUMMY TUCK PROVIDERS NEAR YOU

Is Rectus Diastasis Repair Ever Medically Necessary & Covered by Insurance?

Answers (7)

TUMMY TUCK PROVIDERS NEAR YOU