I am a mom of 3 boys(who were all huge babies) & all c sections. After my last baby I have been having lots of abdominal pain and back pain. I recently was told I have severe diastasis recti. My stomach also hangs over very far at the bottom. Would insurance potentially cover the repairs for these? My last c section was difficult with recovery due to the overhang on my incision from my stomach.
The answer is maybe. You will need documentation that the diastasis is causing medical issues,i.e., back pain, that is not remediated by other forms of therapy, i.e., physical therapy. Insurance typically does not cover the overhanging skin unoless it, too, is causing problems such as persistant irritation resistant to topical treatment, problems with hygiene, etc. Insurance may also require that the skin hang down below the pubis. Insurance companies don't have uniform criteria for coverage of this or most other issues.
They may or not cover it. Most women will develop some kind of diastasis after pregnancy and it usually does not cause any symptoms. The removal of skin and tissue would be very seldom covered and considered a cosmetic operation. Trying to pass this as a medically necessary operation to the insurance company would be considered fraud and should not be done. In certain cases it may be considered necessary but I would say very seldom. A lot of times the patient is considerably overweight and it should not be done unless there is significant weight loss first. Best you can do is to visit a board certified plastic surgeon near you and get their opinion on the subject.
Thank you for your question. The diastasis repair is normally not covered by insurance and is generall considered cosmetic in nature by insurance carriers. You may want to get from your insurance plan specific guidelines on this.
What sometimes may be covered are the following
- Repair of a hernia if present
- Removal of excess skin ( Panniculectomy) but most insurances have very strict criteria to get this covered. Again, reaching out to your insurance company and getting specific guidelines for your specific plan would help you figure out if this may be covered.
In addition to this, please visit with a Board Certified Plastic Surgeon to help you navigate this.
Best of luck!