Tummy Tuck for Recurring Hernia - Insurance Coverage?

I have had a hernia repair 3 times and about to be on my 4th (all for the same umbillical hernia)The surgeon I am currently going to who did repair #3 recommended that I have a tummy tuck to pull the muscles back together and keep the hernia in. I went and had a consultation with a plastic surgeon and he agreed the tummy tuck and being able to fully expose the hernia would fix it for good rather than continual hernia repairs. Would insurance cover the tummy tuck in leiu of continual hernia repair?

Doctor Answers 12

Insurance for hernia repair

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It is possible to get insurance to cover a hernia repair if the muscles are plicated for that purpose but that doesn't make it a TT.  The insurance company won't cover the added time to remove skin and replace the belly button as you would with a TT. 

Dallas Plastic Surgeon
4.9 out of 5 stars 125 reviews

Insurance coverage for abdominoplasty and umbilical hernia

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It will be challenging to get it  covered but I have had a few similar cases where the rectus diastasis (muscle tightening) portion of the abdominoplasty was covered and the skin portion was paid for by the patient. A personal letter & phone call to the insurance company from the general surgeon and plastic surgeon explaining the rational for the procedures may help.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 76 reviews

Insurance Will Not Pay For A Tummy Tuck Done In Conjunction With A Hernia Repair

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The simple, but unfortunate, answer to your question is that insurance will not pay for a tummy tuck done in conjunction with an umbilical hernia repair. Even though the muscular technique used in a tummy tuck helps with the reliability of the hernia repair, and avoids the use of synthetic or other forms of mesh, insurance will not pay for it. Any tummy tuck procedure done with a hernia repair will have to be paid for as a separate cosmetic procedure. The hernia repair will be covered by insurance. 

Insurance and Tummy Tuck

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Insurance questions are always tricky because the only way to answer them definitively is to know the details of you plan.  However, in my experience, insurance companies often allow "add on" procedures like a tummy tuck if they are done concurrently with another abdominal procedure.

Even if your insurance company does "preauthorize" your surgery, there is no guarantee that they will pay for it. Be sure to find out the policies for such a circumstance at your plastic surgeons office.  Getting a bill for the tummy tuck is a nasty surprise.  You should be aware of the costs and make plans should this happen to you.

Hope this helps

Insurance and TT

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Unfortunately, insurance does not cover a tummy tuck. Occasionally with documentation of recurrent infection they will pay for a panniculectomy (simply removing loose skin).

Insurance coverage for a hernia repair and a tummy tuck

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

A tummy tuck is a safe and effective way to contour the abdomen and help you resume your previous figure. In our practice, we commonly performed the surgery with other surgeries that the patient may require. We often work with a general surgeon and or a gynecologist who may perform additional procedures at the same time. Surgeries that we have performed in the same setting as a tummy tuck include hernia repair, hysterectomy, fibroid surgery, tubal ligation and even a gallbladder removal. Patients appreciate having one recovery process for both surgeries. Because of our extensive experience in performing these combination procedures, our office is well-versed in working with insurance companies in these cases.

Your best bet is to work with a board-certified plastic surgeon who is very experienced in abdominoplasty and has a good working relationship with general surgeons, gynecologists, and other specialists that may be involved in your combination surgery.

Insurance and coverage for a hernia repair

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I would agree with Dr. Buford.  Insurance companies have proven so difficult to work with that it almost isn't worth the time.  If an insurance covers the expense of the hernia repair in a hospital or surgicenter center the remaining fee for the hospital for the tummy tuck is likely to exceed any money you get back from the insurance company if they pay.  It is likely just as economical to find a plastic surgeon to do both and just pay to have it done right.

Will insurance cover my tummy tuck

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Even if you are having an umbilical hernia procedure performed during teh tummy tuck itself, it is extremely unlikely that any insurance company will pay for this.  They might offer partial payment but only for the expenses associated with repair of the hernia itself.

I would not waste my time bickering with the insurance company.  In the end, you will waste a huge amount of time and probably get very frustrated (as I have had when I used to work with them). Find a good Board Certified Plastic Surgeon and have them fix it during your procedure.  You will be glad that you did!

I hope that helps!

Insurance Coverage for an abdominoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

In my experience insurance companies will pay only what they "allow" for the typical umbilical hernia repair which is much less than the usual charge for an abdominoplasty.  They generally will not pay for the abdominoplasty.  You can try to get pre-authorization with a letter from your plastic surgeon.  If you are turned down at least you will know ahead of time what it's going to cost you out of pocket.  If you have had three repairs already I suspect that you need more than just having the muscles pulled together.  The recurrence rate is higher if that is all that is done.  Often a mesh be sewn over the area once the muscles have been sutured together to strengthen the repair.  The exposure will be much greater with an abdominoplasty approach plus you get the TT out of it.

Lori H. Saltz, MD
San Diego Plastic Surgeon
4.3 out of 5 stars 29 reviews

Insurance coverage for tummy tuck

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

In most instances the tummy tuck will not be covered by the insurance but you can have your plastic surgeon compose a letter of predetermination of benefits to your insurance provider.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 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.