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Diatsasis Recti -Need Answers! 7inched seperated!Insurance won't cover!

tdeforest17
on 5/19/07 5:52 am
O.k I am a very tiny person and my abdominal muscles have been seperated for 3 years,me haveing 2 pregnancies during this time. My belly sticks out like I am pregnant they gap between is about 7 inches! I have been to my doctor a general surgeon a plastic surgeon and they all say a tummy tuck is what will fix this (wich I also have a hernia which was caused by my muscles being seperated. They all say it will not be covered under insurance! Oh my gosh! I don't understand how this cannot be covered due to the fact it has caused a hernia and if I get just the hernia repaired,I will possibly keep having them. So I asked them the procedure code for a pullectomy (i think that's spelled wrong ) and called my insurance and my insurance covers this procedure at 100%. SO my problem is the doctors won't say it is medically neccesary,when it is so obvious that it is. I have no idea what to do ,because when I am out drinking guys come up and tell me I look cute with my pregnant belly and I am not pregnant! I don't know what to do ,because the plastic surgeon and her nurse told me that the hernia was most likely caused by the muscles being seperated,and if I don't get this fixed my intestines could come through. The thing is my doctor won't word it right because he doesn't specialize in that feild ,and just refered me to a surgeon.I can understand if they are only seperated 1bout 1 inch but there has to be a number of inched the seperation is for it to be covered,it could cause major prblems down the road .I would think.
rainsom
on 5/19/07 10:55 am
I think you need to get a second opinion, perhaps change doctors. Sometimes you just get a doctor that just has a blind spot t'ward you. Either that or they are not explaining thing to you very well. Even insurance web sites recommend you get second opinions when you have doubts. Trying finding people in your area that can recomment someone to you?
Donnamarie
on 5/19/07 11:57 am - NY
Hi Theresa, The first thing you need to do is read your insurance policy and then call them and have it all explained!!! Diastasis rectis is not covered by insurance. HOWEVER, the hernia would be. What I think the PS's might be telling you is that while the hernia would be covered, the diastasis rectis AND the TT would not. However, with a hernia, much of the time a panniculectomy IS covered, which is removal of the redundant skin. Sounds like a bunch of insurance hooey, huh??? I had severe diastasis rectis as well, and while it should be considered medical, apparently it's not. Go figure. Definitely get to your insurance company and talk to them, and then you might want to go to a surgeon that has some experience with WLS patients. I think that might be helpful. Good luck!! Donna
Robert Oliver
on 5/20/07 12:44 am - Birmingham, AL
Unless you've had surgery on your abdomen prior, it is likely you in fact have a diastasis rather then a true hernia. While it may resemble a hernia clinically, it represent merely weakened abdominal wall fascia rather then fascia with a defect (hernia) in it. This is almost never covered under insurance. There is no medical risk associated with rectus diastasis. Your insurance carrier likely has a specific policy position on this issue which can be found on their website most often. The only way to distinguish a large diastasis fom a hernia is to have a CT scan done which can document the integrity (or lack therof) of the abdominal wall.