Can we use HSA/FSA funds for diastasis recti when combine with an abdominoplasty?

HSA's are usually explicit in not covering cosmetic surgery, and diastasis repair as part of a tummy tuck is considered cosmetic. If there was a true hernia, it might be different, but it is still asking for trouble to combine cosmetic and medically necessary procedures with separate billing.

Probably not.  Is it medically necessary?  You will probably find through checking with your employer that an abdominoplasty with diastasis recti is not eligible for reimbursement with a FSA, HSA, HRA, LCFSA or a DCFSA as it is considered a cosmetic procedure. You might be able to use HSA or FSA for the lab work.

An abdominoplasty procedure consist of removing the excess skin as well as tightening the muscles to repair diastasis recti.  This is a cosmetic procedure and there are not any insurance companies that would cover this.  The procedure that is covered under insurance is a panniculectomy.  A panniculectomy is removal of the lower abdominal skin only, no muscle tightening, no umbilical movement.  It is not a pretty procedure and usually reserved for patients who have a very large abdominal "apron" which they have had problems with rashes and infections.As far as payment, most HSA accounts are used for health related issues.  It is a fine line to use that for an abdominoplasty procedure as the procedure has to be medically necessary.  This is something that you should discuss with your company.Hope that helps.

Hello and thank you for your question.   Although you would be best served with an in-person consultation, in my practice, a tummy tuck is a cosmetic procedure and I have not come across any health insurance that will cover the surgery.  On occasion, panniculectomies may be covered, but those must meet strict criteria. Please refer to your HSA details to be sure.  In terms of the tummy tuck, be sure to seek a consultation with a board-certified plastic surgeon who specializes in aesthetic plastic surgery and be sure he/she addresses all your concerns about an abdominoplasty and discusses the surgery details including the risks and benefits of the procedure, recovery time, and post-operative course.  In terms of the abdominoplasty details -- the necessary skin and fat is removed, the abdominal muscles are plicated (tightened), a small umbilical incision is made that is not externally visible (to give you an "innie" belly button), and a short, low waistline incision is designed to be easily hidden by your underwear or bikini.  Please view plenty of before-and-after pictures in real patients (and not just computer-generated images) who have a similar abdominal appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome.  And lastly, I think the most important component of the consultation is to establish a good connection with your plastic surgeon.  If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For further information on tummy tucks, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS

Harvard-trained Board Certified Aesthetic Plastic Surgeon

It would really be dependent on your HSA policy. In general it is hard for a plastic surgeon to say a tummy tuck is medically necessary. Check in with your HSA policy, but usually a tummy tuck is considered a cosmetic procedure. 

A tummy tuck is a luxurious, non-medically related cosmetic surgery. It is not necessary. Using money intended for healthcare is not ethical. 

Our patients commonly spend HSA funds to correct symptoms related to diastasis recti, umbilical and ventral hernia, and other post-pregnancy related disabilities by abdominoplasty ("tummy tuck").

That’s a fascinating question and I don’t know the answer. You could ask your accountant or attorney. I will bet , however, it has been done in the past. I don’t know how risky it would be to try it and what penalty there might be. Again, questions to ask a lawyer. Then you have to ask yourself if it’s even worth the risk and penalty no matter how small.  it’s at best a grey area and you would need a letter of medical necessity from your surgeon. Personally I would not want to involved because it could be viewed as tax fraud.

Thank you for sharing your question.  In general the use of HSA funds is at the discretion of your company's policy and should be reviewed with them for their potential use.  As a diastasis repair is often corrected at the time of an abdominoplasty, your surgeon may not accept payment, in which case you would need to find another provider for assistance.  

This question comes up every now and again during consultation so I've already looked into it.  The guidelines for acceptible use of HSA/FSA clearly state that HSA/FSA cannot be used for elective cosmetic surgery.  Despite the improvement on your life that is conferred by a repair of your abdominal wall integrity and removal of excess skin, the abdominoplasty is still considered as elective cosmetic surgery.  If the HSA/FSA is run and either the patient or the doctor triggers an audit, the consequences could be pretty severe.