Will Insurance Pay To Repair My Separated Abdominal Muscles?

Q: Dr. Eppley, I have had five pregnancies and my muscles are separated as well as I have a skin flap that hangs down. My back hurts all the time since my stomach muscles are so weak. My skin flap hangs down and rubs on my thighs. I have done physical therapy but it doesn’t help. My insurance says they won’t cover it and I can’t afford to get it fixed on my own. Being in this plight, how can I get my insurance company to pay? It seems like they should but they just don’t understand. What do you suggest?

A: The reality of medical insurance today is that coverage will not be provided for ‘muscle separation’, medically known as a rectus diastasis. While this is a common occurrence after multiple pregnancies, it is not interpreted as medically necessary to repair by the insurance industry. There is no getting around this ruling nor do such symptoms as muscle weakness make it possible for insurance to pay for surgery. It is different if an umbilical hernia is present as this is a true defect in the abdominal wall. The same consideration applies to abdominal skin flap surgery, known as an abdominal panniculectomy. Only in large abdominal pannuses that hang way down onto the thigh and have associated chronic skin infections underneath will insurance consider coverage for its removal.

Dr.  Barry Eppley

Indianapolis, Indiana