Q: Dr. Eppley, I need diastasis recti muscle repair. I need to see if your office can do a pre determination through my insurance for this procedure. I have chronic low back pain and do not want to continue to take 500-1000 mg of Naproxen for life or Cortisone injections.. I have joined weight watchers and lost 15 lbs and I am not morbidly obese but my back makes my quality of life poor. I cannot jog, run. I cycle 30-60 miles or more a week indoor spinning. I cannot lose my belly since my csection no matter how hard I work out. Can you please help. My back is getting worse and I’m at my wits end. I know that insurance can pay for alot of the procedure but I know I will need abdominoplasty also, but please can you help!
A: Thank you for your inquiry but I am not sure where you are getting information that would indicate that insurance would pay for a diastasis recti muscle repair…as they will not. Insurance only covers two adbominal type procedures for medical reasons…a hernia and in some cases an abdominal panniculectomy. A hernia is not the same as a diastasis of the rectus muscles. A hernia is an actual defect in the abdominal wall where bowel may or may not poke through. A diastasis is a separation of the midline of the vertically oriented rectus muscles but is not an actual defect of the abdominal wall. Most women have a rectus diastasis of various widths from pregnancies. Insurance will cover repair of an abdominal wall defect (hernia) but not for a muscle separation that is not associated with a hernia
In tummy tuck surgery it is common to have a diastasis recti muscle repair with the removal of extra skin and fat. While it is part of almosyt every cosmetic tummy tuck it is not a medically necessary procedure as defined by insurances.
Dr. Barry Eppley