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.
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
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
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
Yes, tummy tuck can be done at same time as hernia repair
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.
Unfortunately, insurance does not cover a tummy tuck. Occasionally with documentation of recurrent infection they will pay for a panniculectomy (simply removing loose skin).
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
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.
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!