Will Tricare Cover Abdominal Muscle Plication?

Question

After having my daughter, I realized I had diastasis recti. I have not been able to correct it with exercise and it is causing abdominal bulging and back pain though not severe. I was wondering if anyone knew or had an experience when tricare covered abdominal muscle plication. And if so, if that covered procedure could be done in conjunction with an elected procedure (breast augmentation). Thank you!

Vivek Bansal, MD · Answer

First call your insurance and see if that is a covered procedure. Next, if they cover the procedure, only that part of the procedure is covered. You will have to pay for the other part and split up the anesthesia part of the procedure. We recommend wearing the garment part of the day to minimize the swelling.

Matthew Schulman, MD · Answer

Separation of the the abdominal muscles - rectus diasthasis - is very common after pregnancies. Unfortunately no amount of exercise will correct this becuase it is not a problem with muscle strength. The only way to correct this is to suture the muscles back together into the normal position. While I have no personal experience with Tricare insurance, insurance companies regard this problem as cosmetic in nature and will not cover it. In order to be considered "medically necessary", you would need to prove that this is interfering with your abiltiy to perform activities of daily living. In my experience, this is difficult (probably impossible) to demonstrate.

Tom J. Pousti, MD · Answer

I have never had an "insurance" entity authorize tummy tuck surgery or plication of the abdominal wall muscles. In other words, insurance companies do not consider this operation medically necessary. Best wishes.

Robert L. Kraft, MD, FACS · Answer

Historically, insurers would consider payment for the portion of an abdominoplasty associated with the diastasis. However, they have all tightened criteria in the past few years and now reject diastasis as cosmetic in nature. Insurers are required to post their criteria for coverage online so I recommend that you review these. Tricare is generally restrictive and requires preauthorization for all procedures.

Marcus L. Peterson, MD · Answer

After spending many years in the Air Force as a plastic surgeon and now practicing outside the military I can tell you that Tricare does not cover the repair of a rectus diastasis.  Keep working on muscle toning and core exercises and this should help your back.  A formal abdominoplasty should help with all of the issues you have described but this is considered cosmetic.

	Best Wishes

	Dr. Peterson

Will Tricare Cover Abdominal Muscle Plication?

Answers (5)