In most cases the insurance will cover the hernia repair for the surgery. However, they will not cover the abdominoplasty surgeon fee or the operating room or anesthesia fees for the abdominoplasty.
Patients often think that, “since I am in the operating room anyway, I will just get another procedure done.” This is possible, but the insurance companies are no fools. They will cover the medically indicated part only.
The other consideration is that not all plastic surgeons participate with insurance companies.
This is because the insurance companies often do not pay even close to what the surgeon would normally charge (they may pay only 5% or 10% of the normal fees).
Also, the insurance companies often require an extensive amount of paperwork and prior authorizations which usually makes the whole process ridiculous.
Talk to your surgeon and they should be able to help you or refer you to someone who can. (David Shafer, MD, New York Plastic Surgeon)
Is tummy tuck covered by Insurance?
Insurance does not cover a tummy tuck but it does cover repair of umbilical or incisional hernias. If a tummy tuck is conducted at the time of umbilical hernia repair the cosmetic portion of the procedure is not covered by insurance. (S. Sean Younai, MD, FACS, Beverly Hills Plastic Surgeon)
It is very difficult to get insurance coverage when tummy tuck is involved
In my practice, I just offer the hernia repair as part of the tummy tuck operation. It is very difficult to get approval for just the hernia repair. Once there is a cosmetic component, the insurance company will tend to deny it.
The only saving any way will be the portion of the anasthesia and surgery center fees related to the hernia repair. This is minimal any way.(Hisham Seify, MD, PhD, FACS, Orange County Plastic Surgeon)
The repair of an umbilical hernia during a tummy tuck is such a tiny 5 minute procedure that I do it for free. Even if you tried to get insurance involved in this I would guess it would only cover a very small part of the total cost. (Richard P. Rand, MD, FACS, Seattle Plastic Surgeon)
Depends on how good your insurance is.
An umbilical hernia repair is a relatively simple procedure usually performed by a general surgeon and only involves a small incision around your umbilicus. This may be covered by your insurance but is a much smaller procedure than a tummy tuck.
A full tummy tuck involves a larger incision in your lower abdomen, raising the skin and fat off of the abdominal muscles. The rectus abdominous muscles which usually have spread apart from pregnancy are then sutured together. This gets rid of the abdominal bulge and often corrects small umbilical hernias.
Insurance companies are all different in how they approach patients doing this kind of surgery and many plastic surgeons accept no insurance as the companies often deny payment for aesthetic surgery even if there is a functional component – so there is no easy answer to your question.
If your plastic surgeon works with a general surgeon, then the general surgeons fee for the hernia repair might be covered, but you will have to pay the plastic surgeon. If your insurance company pays for the joint procedure then it is possible that part of the anesthesiologists and hospital charges may be covered (William B. Rosenblatt, MD, New York Plastic Surgeon)
Umbilical hernias are typically covered
I find that umbilical hernias are common, and covered by insurance. The tummy tuck is cosmetic and therefore, not covered. I will either do the umbilical hernia or have a general surgeon do the hernia repair.
This is a great time to do the abdominoplasty, and you and your plastic surgeon should be able to work out something. (Scott E. Kasden, MD, Dallas Plastic Surgeon)
Tummy tuck and hernia covered by insurance
The hernia should be covered by insurance. The tummy tuck portion will not be covered. You will most likely have to pay for the extra OR time and anesthesia as welll as your surgeon’s fee for the tummy tuck. (Steven Wallach, MD, Manhattan Plastic Surgeon)
There is no reason not to do the two procedures together and many plastic surgeons and general surgeons will work as a team to get this done. There may or may not be some savings. You and your doctors will need to work this out with the insurance co. (Robert D. Goldstein, MD, Bronx Plastic Surgeon)