Tummy Tuck with Muscle and Hernia Repair Covered by Insurance?

I need an umbilical hernia and abdominal muscle repair, and I would like to get a tummy tuck at the same time. I am pretty sure that my health insurance will cover the hernia repair. Is it possible for me to just pay the additional costs out of pocket for the tummy tuck portion of the surgery? Is this feasable? Would most surgeons agree to this? Thanks in advance for your insight!

Doctor Answers 37

Insurance coverage becoming more difficult to obtain for supposedly "covered" features

Health insurance companies are in business to take your premiums and hold onto your money as long as possible. Of course, many factors come into play whether your particular company will cover the medical problems that you mentioned. Much of it has to do with YOUR personal policy with the insurance company. It is becoming increasingly more difficult to have "covered" features in your policy covered!

To avoid problems, begin with a consultation with a board certified plastic surgeon who is experienced in body contouring, particularly tummy tucks. After a thorough evaluation and physical examination by the plastic surgeon documenting your medical issues, have his/her office contact the insurance company and obtain in writing what the insurance company's position is. Do not be surprised if additional evaluation/treatment(s) by other specialties are required. Hopefully, your insurance company will prorate the medical treatments related to the hernia repairs from the cosmetic portion.

My very best wishes for a happy outcome.

Englewood Plastic Surgeon

Your payment compromise should work fine

Combining hernia and muscle repair with a tummy tuck isn’t actually all that unusual. You’re correct in thinking that most insurance providers are likely to cover the cost of your hernia repair, but not the tummy tuck portion of the surgery. As long as you discuss paying for the additional costs out-of-pocket with your surgeon prior to your procedure, your insurance provider shouldn’t have a problem with both surgeries being performed at the same time. Of course, you should contact your plan administrator first to verify.

Nirav Savalia, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 42 reviews

Hernia repair with tummy tuck

Thank you for your question.  Repair of a small, uncomplicated umbilical hernia is very commonly performed by the plastic surgeon as a part of the tummy tuck operation.  Insurance will usually cover the hernia repair; the tummy tuck (with associated OR and anesthesia time) is paid for out of pocket.  In the event that insurance approval for the hernia cannot be obtained, many plastic surgeons will perform this either free of charge or at a small additional fee.

A tummy tuck is considered cosmetic and elective

It’s not unusual to perform a tummy tuck at the same time as a hernia and abdominal muscle repair. However, as you noted, the tummy tuck portion of the surgery isn’t likely to be covered by insurance, and you’ll need to pay out of pocket for that. I would start by checking with your insurance company to see if they have any recommendations for how to proceed. It’s possible you will need two completely different surgeons who have to be willing to coordinate on this issue with you. I do recommend looking for a board certified plastic surgeon for your tummy tuck rather than having a general surgeon perform both aspects of your surgery.

Possible, but ask provider

This is possible but you will have to talk to your insurance provider and surgeon to find out the details of payment. 

Yes, tummy tuck can be done at same time as hernia repair

Dear Donna,

It is quite common to have a tummy tuck at the same time as a hernia repair.

You will need to find a general surgeon and plastic surgeon who are willing to work together.

The insurance would cover the hernia repair and you would pay an extra fee for the tummy tuck

Ask your doctor who plans to do the hernia to rtefer you to a board certified plastic surgeon who can do the hernia repair.

Tummy tuck combined with hernia repair

This is a frequent question, thanks for asking. You are correct in your assumption that your insurance company will likely pay for your hernia repair but not your tummy tuck. It is not uncommon to perform these two procedures at the same time. You would be responsible to pay the out of pocket costs for the tummy tuck (including the facility fee and anesthesia time for the tummy tuck portion of the procedure). By combining the two procedures you will only have to go through one recovery period. Good luck!

Healthcare insurance coverage for tummy tuck and umbilical hernia

Thank you for your question. Yes, it is completely doable. Tummy tuck is an operation that can be used not only for cosmetic improvement but also for repair of an umbilical hernia and rectus muscle separation or diastasis. The insurance is typically only going to cover for the medically necessary parts, like the hernia or diastasis. You must, however, show that these are causing medical problems. In order for the surgeon, anesthesiologist, and facility to get paid, you are going to have to show a medical necessity and insurance preauthorization. Any cosmetic parts to the surgery will be your responsibility. Make sure that you visit with a Board-certified plastic and reconstructive surgeon with ample experience in tummy tuck surgery. That is your best bet. Hope this helps. Good luck and farewell. 

Tummy Tuck with Muscle and Hernia Repair in Melbourne, Florida

It has become increasingly difficult to predict what insurance companies will do regarding coverage for many procedures. While they are supposed to cover hernia repairs, they definitely will not cover any cosmetic surgery including a tummy tuck, and therefore, that part would be an out-of-pocket expense. If your insurance company is not being completely forthright or cooperative, you may be able to negotiate a prepay fee for the hernia repair with your surgeon. I would recommend discussing this at length with your board-certified plastic surgeon.

Amy Ortega, MD
Melbourne Plastic Surgeon
5.0 out of 5 stars 32 reviews

Tummy tuck with muscle and hernia repair covered by insurance?

Hello! Thank you for your question! Surgical procedures for aesthetic purposes, to improve appearance, are not covered by insurance. Typically, these as well as complications resulting from such procedures are the responsibility of the patient. Procedures that are meant to correct functional issues and those which cause health-related issues should be covered by your insurance as a medical necessity, with proper examination and documentation. Some insurance plans have exclusion criteria for certain procedures. Also, it is an obligation of the surgeon not to attempt to authorize purely cosmetic procedures through insurance.  This is an excellent time to combine these procedures.  The facility and anesthesia time should begin upon completion of your hernia repair.

Discuss your issues and complaints with a board-certified plastic surgeon to discuss these as well as to examine and assist you in deciding which procedure(s) will be the best for you. A discussion of the advantages and disadvantages will take place along with the risks and benefits. Insurance companies will vary on coverage and is always reasonable to discuss your issues with your surgeon and primary care. It would behoove you to get as much information as possible and even call your insurance yourself. Certainly, pay in advance prior to your surgical procedure and options such as financing are available if you qualify. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 25 reviews

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.