Will insurance cover any portion of a Tummy Tuck if a hernia repair is also done?

I was just diagnosed with a hernia and a plastic surgeon told me that if the TT is done in a hospital the insurance will cover the cost of the anesthesia and the hospital. What is the typical cost of a TT in the NY area.

Doctor Answers 11

Insurance and TT

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Unfortunately, insurance does not cover a tummy tuck. Occasionally with documentation of recurrent infection they will pay for a panniculectomy (simply removing loose skin).

Cost in NY

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Please ask some board certified doctors in your area for the cost. It can save you some money to do it this way as the other posts have stated. The key is for the doctor to follow a proper ethical treatment plan. There are a number of doctors who falsify documents for their personal financial gain in cases such as yours. Good Luck! It sounds like you are on the right track.

Gregory T. Lynam, MD
Richmond Plastic Surgeon
4.9 out of 5 stars 62 reviews

Cost of TT

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Insurance policies may cover a ventral wall hernia repair or an umbilical hernia repair.
If the your insurance company precertifies the procedure, it will cover the functional aspect of the surgery, anesthesia, and facility/hospital fee. It will not cover cosmetic surgery.
An abdominoplasty may have a functional and also a cosmetic component.
The total cost is individually dependent based on the degree of the problem, the surgeon's fee, and the insurance coverage.

George C. Peck, Jr, MD
West Orange Plastic Surgeon
4.8 out of 5 stars 25 reviews

Tummy Tuck with Hernia Repair

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At the facilities I work in the patient is responsible for all of the cosmetic portions of any case. This means that you will pay for anesthesia and use of the operating room for the cosmetic part. Where you do save some money is that you do not have to pay for the recovery room, overnight stay(if necessary) or physician assistant. The reason for this is because you need these things for the hernia repair regardless of whether or not you are having a tummy tuck. 

Tummy tuck pricing varies depending on exactly what you need. A regular tummy tuck cost approximately $8,000.

Insurance coverage for a hernia repair with a tummy tuck -Beware of Insurance Fraud.

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You are right, that most insurance will cover the hernia repair. This means that your insurance will pay for the anesthesia and operating room for the time it takes to repair the hernia only. The other time is used for an elective cosmetic procedure ands is your financial responsibility. What this means to you is that you will likely save some percentage of money (maybe a few thousand dollars) off the cost of your tummy tuck. Unfortunately, many of my colleagues in the NY area use this as an incentive to get patients to book the tummy tuck and say that the entire anesthesia fee and operating room fee will be billed to insurance, making the tummy tuck price very cheap. This is insurance fraud. If your surgeon is willing to cheat your insurance company, than it should say something to you about them as a surgeon, doctor, and person.  Ethical plastic surgeons will never submit the entire anesthesia and facility bill to insurance company simply because you also have a hernia. Beware of surgeons who do this.

Hernia Repair with Tummy Tuck

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Thank you for your inquiry.  Most insurances will cover hernia repair and sometimes you need prior authorization.  You have to consider your deductibles in the process as some patients have over $ 10,000 deductible.  Depending on how much liposuction needs to be performed, average cost is about $ 7,500 to $ 10,000.

TT and hernia, insurance coverage

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The insurance company will cover the hernia, and a portion of the TT. Bringing you in the room, putting you under anesthesia and draping you as well as the TT incision up to the belly button will be covered usually, in addition to putting on dressings and getting you out of the room. The rest is cosmetic. That is how it works with my hospital. Costs vary depending on what you need done to achieve your goals.

Rick Rosen, MD
Norwalk Plastic Surgeon
4.8 out of 5 stars 28 reviews

Insurance may cover a portion of an abdominoplasty if a hernia exists.

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Insurance coverage varies from policy to policy. If an umbilical hernia or incisional hernia is fixed concurrently with an abdominoplasty the insurance company might cover this portion of it.

Insurance coverage for hernias and tummy tucks

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In my experience insurance companies will cover the cost of hernia repairs, including the fsurgeon and facility (hospital or ambulatory). The insurance company will not cover any of the cost for the cosmetic tummy tuck.

Tummy tuck not covered

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Typically the hospital will separate the time and costs for each individual procedure and will bill insurance only for the portion pertaining to the hernia repair, you will be responsible for the tummy tuck portion.

Mennen T. Gallas, MD
Katy Plastic Surgeon

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.