How to Get Insurance to Cover Diastasis Recti Surgery

Diastasis recti is a condition in which the abdominal muscles have separated. When a woman is pregnant or for other reasons, the muscles can separate. If you have this condition, you may need surgery to correct it.

Diastasis recti surgery can be performed alone or in conjunction with a “tummy tuck.” Everything you need to know about diastasis recti surgery will be covered in this post. You’ll discover why it’s done, what to expect during surgery, and how long it will take to recuperate.

What is Diastasis Recti?

Diastasis rectus is a condition in which a gap appears in the middle of your abdominal muscles. If you’re pregnant, these muscles separate in the later stages of pregnancy. The illness can affect babies as well as the elderly.

Diastasis recti is a separation between the abdominal muscles that is the breadth of two fingers or more in an adult.

If you have the problem, you’re more likely to develop a hernia, have difficulty managing your urine (incontinence), and suffer from low back pain.

Diastasis recti can sometimes improve on its own. If you do activities that work your abdominal muscles, it might help.

If it doesn’t get better, you’ll need to have surgery to fix the problem. A surgeon can close the space and reconnect the muscles. This can be done by itself or as part of an abdominoplasty. This is also called a “tummy tuck.”

Many people feel better after they have surgery to fix diastasis recti. However, there are some things that you should know if you are considering it.

Is Diastasis Recti Surgery Covered By Insurance?

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 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 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… 

  • Detailed documentation of their years of physical therapy and
  • Doctors’ recommendations for surgery

. . . but still lost their case and had to pay out of pocket.

Partial Coverage for Hernia

Diastasis patients often have a hernia and insurance companies will often cover that portion of the surgery. Hernia repair is usually only a fraction of the overall cost. To get tips on how to pay for this important surgery despite its lack of insurance coverage, see my tips at the bottom of this article.

Does physical therapy fix 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 regular DR exercises helped me manage my discomfort 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! My physical therapist advised me to get surgery.

How to prepare for Diastasis Recti Surgery

STEP 1: Start saving for surgery

How much does diastasis recti surgery cost?

Diastasis Recti Repair Surgery can easily cost between $6,000 and $25,000+, according to a poll given to my DR Mom friends. A few patients were able to get the surgery covered by insurance, but the majority paid out of pocket.

The cost of surgery depends on:

  • 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 (Often includes the cost of a surgical center, but hospital stays are often 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 until you’re done having children

Because the surgery is expensive, doctors will recommend you wait until you’re done having children to have surgery to repair DR. I loved using the MUTU System while I had two more children and saved up for surgery.

How to pay for diastasis recti surgery if not covered by insurance

If you’ve decided to have your DR surgically repaired, but are unable to get your diastasis repair surgery covered by insurance, here are some tips for saving:

  • 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 sceptic of the expense since he or she is a saver.
  • One of my mental shifts occurred when I realised 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 can gradually increase your funds without having to think about it. Don’t wait for money to be left over—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: Select surgeons and schedule a consultation

What kind of surgeon repairs Diastasis Recti?

Diastasis Recti can be repaired by a general surgeon or a plastic surgeon. Once I accepted that my surgery was unlikely to be covered by insurance, I focused exclusively on plastic surgeons. I did this 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.

STEP 3: Consult with / Interview surgeon

I had a long 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.

Questions to Ask Potential Diastasis Recti Surgeons

  • What method do you use to execute the surgery? Please elaborate on your technique.
  • Make an incision(s) in the following ways and places: (Incisions along the bikini line are preferred by the majority of patients.)
  • What’s the best way to make a new belly button? (Tip: look at the belly buttons in before/after images when choosing a surgeon with a good-looking aesthetic result.)
  • Do you mend with permanent or dissolvable sutures?
  • Do you suture your own wounds?
  • What types of sutures do you employ? Do you have any experience with running stitches? (Running sutures are not ideal because they are weak.)
  • How long will the procedure take?
  • Do you work with mesh? Note: Do your own study, although mesh has caused severe autoimmune reactions in some people. My surgeon was able to fix my diastasis without the need for surgery.
  • Do you use drains? Drains aren’t fun, but I recommend them.
  • How do you minimize the appearance of scars?
  • How many layers of closure do you use?
  • Where would you perform the surgery?
  • What is the recovery time? How long will the surgery be?

STEP 4: Start recruiting help

You will need a lot of help to recover from diastasis recti surgery. You will need:

  • Someone who can take care of you for two intense weeks where you may need help doing the most simple things, like getting out of bed. You won’t be able to lift anything for at least six weeks.
  • Someone to take care of your kids while you recover. My husband was balancing working and taking care of me, so we needed extra help to care for our kids. I couldn’t lift anything, plus I needed naps while my tired body healed.
  • I also lined up extra help to get kids to/from school and set up playdates with friends to give my mom a break (who took care of my three kids for a month — she is a saint).

Getting help from friends and family

Even before I planned my surgery, I began contacting my family and friends to see what type of assistance I might be able to get to speed up my recuperation. I asked my mother two years in advance if she would travel out to assist with watching my children because I knew it was a big request.

I began enlisting the assistance of other family members and acquaintances to assist me with my children. I needed help to hold down the fort for weeks because the surgeon I trusted the best lived a short flight and a 6-hour car ride away.

STEP 5: Pay deposit, Schedule Surgery

Many surgeons book their patients’ diastasis recti surgeries months in advance. Most surgeons require you to set up pre-surgery physicals with your general practitioner and blood labs to ensure you are healthy enough for surgery. I have a low resting heart rate, so I had to make an extra appointment with a cardiologist.

STEP 6: The Actual Diastasis Recti Surgery

My spouse and I headed to the surgical centre in the morning. I had final prep photos and exams, then an iv was given to me by a nurse, and I was taken to the surgery room. I awoke following surgery, was transferred to a surgical centre, and then stayed in a recovery centre for two nights.

In my instance, “home” was an Airbnb where my husband and I were sleeping. We stayed there for two weeks because my surgery was out of town and I needed to be there for my two follow-up appointments (1 and 2 weeks post-op).

As difficult as it was to be away from my children for so long (again, my mother is a hero for watching my children), I was grateful for the opportunity to rest.

My kids were happy and taken care of (my youngest was 3 years old). We Facetime-d every day, but my kids were having so much fun with Grandma, they didn’t seem concerned that mom and dad were away.

STEP 7: Rest and Recover

How long does it take to recover from diastasis recti surgery?

The first week of recovery was the worst; the second was better; and so on. The pain was manageable after a few days.

To prevent strain on the muscle repair, the surgeon recommended I not lift anything for six weeks or more. For the first couple of weeks, you may need help with basic things like getting out of bed.

Summary

Diastasis recti surgery fixes muscles in your abdomen that have come apart. The separation can lead to other health problems like hernias. You might also feel self-conscious about how your abdomen looks.

A surgeon can fix your muscles. If you also want to have skin and fat removed or tightened up, you can have a “tummy tuck” or liposuction at the same time as your muscles are fixed. After your surgery, follow your doctor’s instructions for taking care of your body while you are getting better.

If you have healed up but do not like how your belly looks, you can talk to your surgeon again. They might be able to do another procedure to fix it.

A Word From Verywell

People have diastasis recti surgery for a variety of reasons. It can support your body physically, fix hernias, and improve your self-image.

If you’re thinking about having the surgery, choose an experienced surgeon that you trust. Every surgery comes with risks, but some more so than others. Your surgeon can talk to you about the risks and benefits of having diastasis recti surgery and decide which one is best for you.

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