Hey, fellow policyholders, let’s chat about something that might be off everyone’s radar. However, for those it affects, it’s a pretty big deal—diastasis recti. Yeah, that tricky condition where your abdominal muscles take a bit of a hiatus from each other post-pregnancy or for different reasons. If you’re wrestling with this and thinking about surgery, you’re probably also fretting about the numbers. But before you dive into your savings, let’s talk about your insurance plan—the potential knight in shining armour.
In this insider’s guide, I will walk you through the maze of getting diastasis recti surgery covered by insurance. There’s no need to pull out your hair in frustration; I’ve got some practical steps and nifty tips to help boost your chances of getting approval. So, please grab a cup of coffee, and let’s start unravelling the mystery of insurance claims for diastasis recti surgery. Trust me, it’s less about luck and more about knowing the right moves!
How do you get diastasis recti surgery covered by insurance?
Health insurance can be tricky, especially regarding procedures like diastasis recti surgery. Standard health insurance policies usually do not cover this surgery, which fixes the separation of abdominal muscles. But don’t worry! There are ways you can get this surgery covered. Here’s a friendly guide to help you through the process:
- Get to Know Your Insurance Policy: First, it’s essential to understand what your insurance policy covers. Different insurance companies have rules about what counts as a medical necessity. Understanding these can be crucial to getting coverage for your surgery.
- Why You Need the Surgery: To get coverage, the surgery has to be more than just a cosmetic need; it must be a medical necessity. If your diastasis recti is causing you problems, like constant discomfort and hygiene issues, or is part of a hernia, your insurance should cover it.
- Chat with your doctor: Start the conversation with your primary care physician. Explain how diastasis recti affects your daily life. Your doctor can refer you to a specialist, like a plastic surgeon or general surgeon, for a closer look. This step is essential for showing your insurance that the surgery is necessary.
- Schedule an appointment with a surgeon covered by your insurance. Once you have a referral, make an appointment with a surgeon in your insurance network. They’ll assess whether surgery is the best option for you. This expert opinion is a big deal for your insurance claim.
- Document Everything: Keep a detailed record of everything related to your condition: doctor’s appointments, notes, referrals, and anything else that might help your case.
- The Hernia Angle: Sometimes, diastasis recti comes with a hernia. If that’s the case for you, insurance might cover the hernia repair part of your surgery, even if it doesn’t cover the diastasis recti repair. Since hernia repair is usually less expensive, this can significantly help.
Remember, each insurance company is different and looks at every case individually. Being persistent and keeping detailed records will be your best friends on this journey. Good luck!
Tips to get diastasis recti surgery covered by insurance:
Get Familiar with Medical Jargon:
- Understanding medical terminology, especially around diastasis recti, can be beneficial. If diastasis recti has led to hernias or other complications, your insurance coverage odds may improve.
Compile your medical history:
- A comprehensive medical history showcasing consistent pain or discomfort can bolster your case significantly.
Give physical therapy a shot first.
- Insurers often appreciate it when conservative treatments are attempted before opting for surgery.
Seek Multiple Medical Opinions:
- Having a chorus of medical professionals recommend surgery can strengthen your case for insurance coverage.
Keep communication channels open.
- Maintain clear communication with your medical providers and insurance about your intentions and reasons for seeking the surgery.
Hold onto All Paperwork:
- Keep copies of all paperwork, forms, or letters between you, your healthcare provider, and your insurance. They’re your proof and reference.
Document Your Daily Life:
- Maintain a diary detailing how diastasis recti impacts your daily activities and quality of life. This could provide compelling evidence for obtaining insurance coverage.
Moreover, chatting with a board-certified plastic surgeon and your insurance provider to understand all the specific needs and requirements for covering your diastasis recti surgery is highly recommended. This journey may seem daunting, but with the proper steps and persistence, you’ll be on your way to securing insurance coverage for your surgery.
Insurance covers diastasis recti physical therapy.
Insurance covers physical therapy as a treatment for diastasis recti. Physical therapy is the leading treatment for diastasis recti and is typically covered by insurance.
Some insurance companies don’t pay for diastasis recti surgery since it’s cosmetic. Doctors usually start with physical therapy, which is a non-invasive and cheaper alternative to surgery.
Diastasis recti can be treated with physical therapy, which insurance covers. To verify your coverage, contact your insurance company.
Strengthening stomach muscles with physical treatment helps lessen rectus-abdominis separation. Diastasis recti physical therapy comprises posture training, stretching, bracing, and teaching. Diastasis recti exercises can correct mild-to-moderate abdominal separation. In severe cases, you may require physical therapy and pelvic floor physiotherapy to start the healing process safely.
How to get diastasis recti surgery covered by Medicaid
Get a referral from your primary care provider.
You’ll need a referral from your primary care provider to get diastasis recti surgery coverage from Medicaid. They can refer you to a specialist who can evaluate your condition and determine if surgery is necessary.
Meet Medicaid’s criteria for coverage.
Medicaid covers medically necessary diastasis recti surgery. Check with your Medicaid provider for state-specific criteria. Surgery is usually covered if you experience significant abdominal muscle separation and back pain, constipation, or difficulty exercising.
Choose an in-network provider.
To ensure coverage, choose an in-network provider who accepts Medicaid. You can find a list of providers on your Medicaid provider’s website.
Submit a pre-authorization request.
Before scheduling surgery, your provider must submit a pre-authorization request to Medicaid. This request includes your medical history, symptoms, and the proposed surgery. Medicaid will review the request and determine if the surgery is covered or not.
Follow Medicaid’s guidelines for post-operative care.
After surgery, follow Medicaid’s guidelines for post-operative care to ensure coverage. This may include attending follow-up appointments, adhering to a prescribed exercise regimen, and avoiding strenuous activities until cleared by your provider.
Non-surgical options to cure diastasis recti:
Non-surgical options to treat diastasis recti focus on strengthening the abdominal muscles and connective tissues, thereby reducing the separation between the rectus and abdominis muscles. Here are some of the non-surgical methods to address diastasis recti:
- Tailored physical therapy programmes can help strengthen the core muscles and promote healing.
- Effectiveness may vary depending on the severity of the condition.
- Specific exercises that target the abdominal muscles can be beneficial.
- Programmemes like the Tupler Technique® Programme, an 18-week exercise regimen with remote training, weekly live webinars, and online support, are designed to address diastasis recti.
- Other exercise routines that focus on diastasis recti healing can also be pursued during and after pregnancy.
- General core strengthening exercises help reduce muscle separation and maintain a solid and supportive abdominal wall.
Platelet-rich Plasma (PRP) Injections:
- Known as Diastasis Recti Abdominis PRP (DRAP), this treatment involves injecting platelet-rich plasma into the abdominal region to target the linea alba, which can result in improved posture, a flatter belly, and relief from associated symptoms like gastrointestinal problems and lower back pain.
- Although not directly mentioned, maintaining a healthy weight and nutritional balance can support healing and prevent further strain on the abdominal muscles.
Proper body mechanics:
- Learning the correct way to move, lift, and perform daily activities can help prevent the worsening of diastasis recti.
- Posture Correction: Maintaining good posture can also support diastasis recti healing.
Individual responses to these non-surgical interventions may vary, and combining treatments may offer the best results. Consulting with healthcare professionals specialising in diastasis recti treatment can provide personalised advice and treatment plans.
How long does recovery take after diastasis recti surgery?
It can take up to 6 weeks to recover from rectus diastasis correction, after which you can generally resume your normal activities and return to work. During this time, you will also need to wear abdominal compression garments.
The recovery time after diastasis recti surgery depends on the following:
- The type of procedure that was performed
- The overall health of the individual
- patient’s ability to follow post-operative instructions.
Typically, it takes several weeks to fully recover from the surgery.
After the surgery, patients may experience various symptoms and side effects.
Medication can cure these things. They may also wear a compression garment for several weeks to help with swelling and support the abdominal area during healing.
How much does diastasis recti surgery cost?
On average, diastasis recti surgery costs from $3,000 to $19,000. However, it can depend on the specific situation. Several factors can affect the cost of diastasis recti surgery, including:
- Location of the surgery
- A tummy tuck will likely be more expensive than endoscopic surgery.
- Surgeon’s Experience
- type of anaesthesia used
It’s best to compare an accurate estimate of the cost of diastasis recti surgery with that of a local surgeon.