Will Combining A Tummy Tuck With An Insurance-Covered Hernia Repair Save Me Money?
Q: Dr. Eppley, I gave birth to twins over three years ago and since then I now have an abdominal hernia and umbilical hernia due to my abs splitting from being pregnant with twins. I also just have extra skin that exercise will not help with. I currently have surgery scheduled for next month with a general surgeon to fix my hernias. He is doing it laproscopic. I was curious if you would be able to fix my hernias by repairing my abdomen muscles and removing my excess skin. Or if you could do the tummy tuck the same time as my surgery with the general surgeon so that would reduce my anesthesia cost and then my insurance would cover some costs. Please let me know your thoughts.
A: Your questions are good ones and fairly routinue inquiries in regards to combining tummy tucks with hernia repairs. Let me discuss the aspects of such a combination from both a medical and financial standpoint.
Most hernias from childbirth are going to be in the midline between the rectus muscles and around the umbilicus. This would be the standard location for a woman who has been considerably stretched from having twins. In a tummy tuck procedure an umbilical hernia would be encountered, reduced and repaired with the midline rectus muscle fascial plication that is almost routinue in most tummy tucks. I have done this many times and there is good logic in combining these procedures in terms of operative efficiency and recovery. If an open tummy tuck is being done then there would be no need to do a laparoscopic approach to a hernia repair.
The issue of doing the two together through insurance is the intriguing twist to this combination. Contrary to popular perception, there is no financial benefit to putting these procedures together. Many years ago there was but those days have long passed. The hospital is fully aware that a tummy tuck is being done and will charge a full rate for the tummy tuck procedure including OR and anesthesia charges. There is no such thing anymore as the insurance covering the OR and anesthesia charges for a cosmetic procedure when done with an insurance covered operation. Both the hospital and the insurance company consider that fraud so there are extremely vigilant about that issue. Interestingly, doing a cosmetic procedure with a covered insurance procedure in a hospital could very well end up costing you more, a lot more, than having a tummy tuck and the hernia repair being done in a surgery center on a purely cosmetic basis. These are the realities of today’s hospital and insurance economics.
Dr. Barry Eppley