Tummy tuck. Umbilical hernia and abdominal muscle separation, Medicare question. Please help! (Photo)

I have been told that I don't qualify for an item number for the TT, I will have to pay for all hospital costs as my insurance won't cover me. I would be up for around 25k, which we just cannot afford. I am completely miserable being in constant back pain and struggling to care for my twins. Does anyone know if a surgeon could put my hospital stay underneath the hernia repair item number to at least help some of the costs? Any advice on this would be greatly appreciated, Jess

Doctor Answers 4

Medicare question about umbilical hernia and abdominal muscle seperation

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Thank you for your question. You have to get a predetermination from your insurance company to see if they cover your hospitalization. It is your insurance and not the hospital.

West Orange Plastic Surgeon
5.0 out of 5 stars 5 reviews

Abdominoplasty Item Numbers

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Hi Jessy

$25K sounds to be a lot for a tummy tuck, even completely uninsured. 

There is no method of 'creating' an item number for your surgery unless you qualify for the abdominoplasty item number. If your GP is prepared to write you a referral letter that states that you qualify, then your Specialist Plastic Surgeon may be able to accept that for you.

Medicare item numbers are constantly being changed, and the Australian Society of Plastic Surgeons is currently lobbying the Federal Dept of Health to reinstate the ability to provide an abdominoplasty for post pregnancy rectus divarication. Your lack of item number problem might be fixed in a few years, if you are prepared to wait that long for a 'possibility'.

Good Luck

Dr Gavin Sandercoe

Tummy tuck and Medicare

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Hi Jess

Medicare changed the laws regarding the use of MBS codes for tummy tucks earlier this year.

In cases like yours you can no longer use the tummy tuck item number. As you don't have a radiological proven hernia you cannot use a hernia number either.

Muscle separation does not constitute a hernia either.

These are harsh new laws but ones we must obide by.

If a surgeon is willing to deceit Medicare in using a Medicare number for hernia repair then I would think twice in going with him/her.

I hope this helped and good luck

Pouria Moradi, MBBS, FRACS
Sydney Plastic Surgeon

Abdominoplasty Costs

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Abdominoplasty is often a day surgery. You could meet with local board certified Plastic Surgeons who do this. Also, many practices offer payment plans or work with third party financing companies to help make payments easier.

I recommend that you discuss these concerns in person with your Plastic Surgeon.

All the best

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.