Will Tricare Cover Abdominal Muscle Plication?

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.

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.

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.

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.

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

In my experience TRICARE will not cover abdominoplasties even in the case of moderate to severe diastasis rectii.

 

Most likely it would not be a covered benefit but you can have a surgeon write a predetermination letter to  TRICARE. I believe you combining other cosmetic operations would also cause a denial. 

It is highly unlikely that Tricare will cover repair of diastasis recti / tummy tuck. It doesn't hurt to ask, but don't get your hopes up. More than likely you are looking at an out of pocket expense for a TT and BAM.

Tricare will not cover a tummy tuck nor a repair of a diastasis recti which is pretty much universial (to a greater or lesser extent) following pregnancy.  Your back pain may or may not be improved with a tummy tuck and muscle plication.  Even if it is, it is extremely unlikely that it would be covered by Tricare or any insurance carrier.

We have not been successful with Tricare. A tummytuck can be combined with a breast augmentation, but both are considered cosmetic surgery. Since the insurance companies set the criteria, doctors and patients have no control over them.