Hernia, diastasis recti and panniculus causing combined pain, and how to get Medicaid to cover? How much out of pocket?

Question

I have a diastasis recti of about 6" which causes pain, an umbilical hernia that causes pain and a growing panniculus that causes pain and in summer gets infections. Together they're beginning to really start to hurt all the time, both in regular life and when I try to exercise. I'm 5'9" and large-framed. Last July I weighed 303 pounds. Now I'm 250. What weight do I need to be to get these things done? What can I expect to pay cash and what might Medicaid cover? What can be done combined?

Dallas Buchanan, MD · Answer

Thank you for your questions. This is a complex question. In regards to insurance coverage it has been my experience (as a doctor that takes insurance for some of these types of procedures) that Medicaid will often cover hernia repair, occasionally cover panniculectomy (if certain criteria are met), and will never cover diastasis repair. The other factor is that Medicaid will not pre-approve any procedures such as this so you would be taking a big gamble having surgery if after surgery they denied payment, then you would be stuck with that bill. Also, at 5' 9" and 250 pounds, your BMI is over 36 and this puts you at high risk of having complications with any type of surgery. You should have a goal of a BMI of less than 30 at least. If you are having problems with weight loss, you might want to consider looking into bariatric surgery as this can make a significant impact on your situation if you are a good candidate. In the end, I do not think you can rely on surgery to fix all the problems you list and I am sure Medicaid is not going to cover all of it as well. Wish I had better news. Your best bet is to have a consultation with a local board certified plastic surgeon who has experience with doing these types of procedures for insurance payments, but finding that person can be difficult as this type of work is rarely lucrative and often fraught with headache and man-hours to work in the system.Best of luck!

Ronald V. DeMars, MD (Retired) · Answer

To be safe you need to have your BMI as far under 35 as possible and best to be under 30 for best results. Medicaid might cover the umbilical hernia, sometimes the panniculus, and possibly but probably will not cover the diastasis repair.. The real problem may be finding a good surgeon that accepts medicaid. Good luck.

Hernia, diastasis recti and panniculus causing combined pain, and how to get Medicaid to cover? How much out of pocket?

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Hernia, diastasis recti and panniculus causing combined pain, and how to get Medicaid to cover? How much out of pocket?

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