How To Get Diastasis Recti Surgery Covered By Insurance

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Diastasis Recti (DR) is diagnosed in a variety of ways.

Since I was pregnant with my first child eleven years ago, Diastasis Recti had been a part of my life. I felt as though my abdomen was being ripped apart slowly and brutally as my belly grew. Because this was my first pregnancy, I figured everything would go according to plan.

My stomach burst out between my abdominal muscles after my son was born and even after I shed the baby weight (pictured above). Diastasis Recti Diastasis Recti Diastasis Recti Diastasis

I discover Diastasis Recti

After a while, I came across the term diastasis recti. The exercises I used to close the gap were only slightly effective. I looked into surgical possibilities but discovered that diastasis recti surgery should be delayed until after you’ve had your children.

As a result, surgical research was put on hold for a few years. To strengthen my core and manage my symptoms as much as possible, I practiced DR exercises (this is the program I used that helped). In the interim, despite losing all of the baby weight, eating healthy, and exercising on a regular basis, I struggled with lower back pain and an unsightly bulge.

Many DR mothers suffer from low self-esteem and despair as a result of everyday comments from others who mistakenly believe they are still pregnant months or years after their baby is born.

With each pregnancy, my diastasis recti widen.

I had soreness between my abdominal muscles again with my next two pregnancies (both my second and third children weighed 9 pounds). The pain rose slowly but steadily up towards my sternum throughout my last (and final) pregnancy, like a zipper cruelly coming undone.

To try to keep my body together as much as possible and minimize the excruciating pain, I used KT tape. I eventually felt like my abdominal muscles’ connective tissues had been pulled apart. They were just stretched to the point of pain. Regardless, the tearing pains subsided, but I was left with lower back discomfort as my body battled to stay together. People were frequently complimenting me on how cute my round, protruding belly was. I appeared to be attempting to smuggle a watermelon. Watermelon smuggling is HARD.

Recti Diastasis Surgery

This is my second pregnancy.

My mother and I were on our way to the hospital to deliver my third child.

Diastasis Recti was diagnosed by an OB/GYN, who recommended surgery and physical therapy.

The diastasis recti gap was more visible than ever after I had my third (and final) kid. My ob-gyn diagnosed me with diastasis recti and told me that I would eventually need surgery to bridge the gap, but that in the meanwhile, I should consult a physical therapist. For a while, I did physical therapy, but my physical therapist also advocated surgery, so I began studying (and paying for) diastasis recti surgery.

When is Diastasis Recti a serious condition?

If a painful abdominal hernia has formed, Diastasis Recti is considered serious. Because of the extent of the gap, some doctors consider Diastasis Recti to be severe (e.g. four or five fingertips or more). Other doctors take into account DR’s negative effects, which include lower back pain, constipation, and difficulties exercising.

Is Diastasis Recti Surgery Insurance Covered?

Some insurance companies cover diastasis recti surgery, however, it is not always covered.

Diastasis Despite its resemblance to (and often coexistence with) a hernia, recti correction is essentially the same treatment as a belly tuck.

As a result, it is frequently not covered by insurance. If performed by a general surgeon and limited to muscle restoration without skin removal, some people may be able to get the operation paid for by insurance; however, each insurance company is different.

I’ve seen patients with diastasis recti fight insurance companies to get their surgery covered. They were outfitted with…

(1) A detailed record of their years of physical therapy and rehabilitation.

(2) Surgery recommendations from doctors

…yet they still lost their lawsuit and had to pay for it themselves.

Hernia Partially Covered

Patients with diastasis frequently have a hernia, and insurance companies will frequently fund that component of the treatment. Repairing a hernia is usually only a small portion of the total expense. See my advice at the bottom of this page for information on how to pay for this critical procedure despite the lack of insurance coverage.

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Is physical therapy effective in treating diastasis recti?

In my case, my physical therapist (who might be financially driven to recommend physical therapy over surgery) indicated my diastasis (a 6-finger gap) was beyond what physical therapy could help with. While I awaited surgery, doing proper DR exercises helped me manage my symptoms and improve my appearance.

Physical therapy, in my experience (and from talking to other DR moms in this Facebook group + This DR Facebook Group), may help improve functionality. My appearance and functionality improved with exercise, physical therapy, and diet, but the gap remained, restricting my core strength. My intestines bulged as I lay on my back, and I could (uncomfortably) feel and see my food moving through–not normal! To narrow the gap and regain complete ability, my physical therapist recommended surgery.

What to Expect During Diastasis Recti Surgery

STEP 1: Begin putting money aside for surgery.

What is the cost of diastasis recti surgery?

According to a poll of my DR Mom friends, Diastasis Recti Repair Surgery can cost anywhere from $6,000 to $25,000+. The procedure was reimbursed by insurance for a few patients, but the majority had to pay out of pocket.

The cost of surgery is determined by the following factors:

Where do you reside?

What kind of procedures will you require? (mini vs full tummy tuck, hernia repair, skin removal, etc.),

Fees for your surgeon (The cost of a surgery facility is frequently included, while hospital stays are frequently separate)

The price of a prescription (pain and other medications needed for surgery)

You’ll need to have any physical exams and/or lab testing to get ready for surgery (I had to see both a GP and cardiologist to be cleared for surgery)

If you choose an out-of-town surgeon, you will incur travel expenses.

Stay in a surgery recovery facility and/or a hospital (some surgeons perform the surgery as out-patient surgery, some require at least a one-night stay). Complications may necessitate a lengthier (and therefore more expensive) hospital stay.

Recovery time costs money (child care, time off from work, etc.)

Wait till you’ve had all of your children.

Because the operation is costly, doctors would advise you to postpone DR surgery until you are no longer pregnant. I adored utilizing the MUTU System while I was pregnant with my second kid and saving money for surgery.

Exercises for Diastasis Recti

If your diastasis recti surgery isn’t covered by insurance, how do you pay for it?

I was relieved to have the MUTU System assist me to manage my symptoms while I awaited surgery and finished having children. Some patients with less severe illnesses are able to avoid surgery.

If you’ve decided to have your DR surgically repaired but can’t get it covered by insurance, here are some money-saving tips:

Recognize that YOU ARE WORTH IT. One of the most difficult aspects of saving was deciding whether or not I was worth it. I’m the saver in most partnerships, and I’m the spender. Perhaps your partner is a skeptic of the expense since he or she is a saver.

One of my mental shifts occurred when I realized I was willing to spend that much money on a car that would almost certainly not last a lifetime. I concluded that having a fully functional physique for the rest of my life was far more valuable.

START AS SOON AS POSSIBLE. It can take years to prepare and save for surgery. The earlier you begin to save, the better.

SET UP A SEPARATE ACCOUNT so you won’t be tempted to spend your surgery savings on something else.

Set up an AUTO DEPOSIT so you may gradually increase your funds without having to think about it. Don’t wait for the money to be leftover–it rarely happens.

Consider taking on a second part-time job to supplement your income and contribute to your surgical fund.

ASK ABOUT DISCOUNTS, such as using CASH instead of a credit card.

CHECK FOR PARTIAL COVERAGE AND REIMBURSEMENTS FROM YOUR INSURANCE, such as getting the hernia component of the operation covered, or at the very least having your HSA refunded (Health Savings Account).

STEP 2: Choose surgeons and set up a consultation.

What type of surgeon performs Diastasis Recti repair?

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A general surgeon or a plastic surgeon can correct Diastasis Recti. I narrowed my search to plastic surgeons after accepting that my procedure was unlikely to be approved by insurance. This is what I did because:

By definition, general surgeons are just that. I wanted my operation to be done by someone who had done a lot of diastasis surgery fixes before.

A broad hip-to-hip incision is used in most diastasis recti procedures. Despite the fact that almost only my spouse sees my naked midriff, I felt that getting a result that was as aesthetically beautiful as possible would help me mentally after a decade of looking somewhat misshapen.

What to Look for in a Diastasis Recti Surgeon

I used Yelp to find surgeons to consult with. RealSelf.com also has a list of plastic surgeons. Finally, I went with a surgeon who was recommended to me by another DR mom in my Facebook DR Surgery Support Group.

STEP 3: Consult a surgeon and have an interview with him or her.

I had a big list of questions when I went in for my surgery consultation. These questions assisted me in better understanding the procedure and getting to know the applicants I was interviewing. This is a big medical treatment, and I needed a surgeon who could not only do the surgery correctly but also communicate well with me about my worries during the preparation and recovery process.

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