Q: I am interested in and desparately need a tummy tuck. I have checked with insurance and they will cover this procedure if a doctor states that it is medically related. I had a Dr. tell me since I delivered my baby that my stomach muscles have torn and will not grow back. Do you guys have someone that you can refer me to look at my stomach muscles so I can receive my tummy tuck with my insurance or help with your doctors in your office?
A: Unfortunately, much of your perception about insurance coverage for tummy tucks is inaccurate. No health insurance will pay for a tummy tuck, unless one has a large apron of skin (pannus) that hangs down onto one’s thighs after bariatric surgery. (and even then they deny it most of the time) There is no medical justification or reason for a tummy tuck, it is viewed by insurance as a cosmetic procedure. Despite the fact that your tummy may look the way it does from pregnancy, weight gain or loss, or even surgery, insurance views tummy tucks as having no medical benefit. That can be proven by submitting a pre-determination letter (what anyone says on the phone from an insurance company is worthless about whether they will or will not pay) to seek approval.
Pregnancy does not cause stomach muscles to tear. Rather they cause the vertically-oriented rectus muscles to separate and stay apart, particularly around the belly button area. Sometimes this may be associated with a hernia which insurance usually does cover to repair. But having a rectus diastasis (separation) is not eligible for insurance-covered reconstruction.
Dr. Barry Eppley