Surgical Management of Diastasis Recti

A Systematic Review of Insurance Coverage in the United States

Carly M. Rosen, Ledibabari M. Ngaage, Erin M. Rada, Sheri Slezak, Stephen Kavic, Yvonne Rasko

Research output: Contribution to journalArticle

Abstract

BACKGROUND: As elective surgery becomes more popular, the stringency of insurance coverage policies has increased exponentially. Many patients with diastasis recti (DR) are denied coverage of the corrective surgery that has been shown to improve function and quality of life in this patient population. Plastic surgeons are frustrated by the lack of guidelines and sparsity of coverage for surgical correction of DR. METHODS: Fifty-four US insurance companies and Medicare were reviewed to determine their policies of coverage. These policies were compared with the guidelines set forth by the American Society of Plastic surgery and current literature on DR. RESULTS: Insurance company policy for DR repair is not clear nor well established. Of the 55 policies reviewed in this study, 51 had an established policy. Forty of these companies would not cover abdominoplasty to repair DR under any circumstances. Eleven companies required preauthorization to ensure that the patient met the requirements of medical necessity. These requirements differed from company to company. A comprehensive list was compiled of details required for preauthorization. CONCLUSIONS: Insurance company policies do not recognize the spectrum of patients with DR and the necessity of abdominoplasty to relieve symptoms of patients with severe debilitation. The current Common Procedural Terminology coding classifies abdominoplasty to repair DR solely as a cosmetic procedure. Policies for DR repair should be amended to include a functional procedure reimbursement for severe DR and include detailed guidelines for coverage requirements to simplify the reimbursement process.

Original languageEnglish (US)
Pages (from-to)475-480
Number of pages6
JournalAnnals of plastic surgery
Volume83
Issue number4
DOIs
StatePublished - Oct 1 2019

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Insurance Coverage
Abdominoplasty
Insurance
Guidelines
Current Procedural Terminology
Plastic Surgery
Medicare
Cosmetics
Quality of Life

ASJC Scopus subject areas

  • Surgery

Cite this

Surgical Management of Diastasis Recti : A Systematic Review of Insurance Coverage in the United States. / Rosen, Carly M.; Ngaage, Ledibabari M.; Rada, Erin M.; Slezak, Sheri; Kavic, Stephen; Rasko, Yvonne.

In: Annals of plastic surgery, Vol. 83, No. 4, 01.10.2019, p. 475-480.

Research output: Contribution to journalArticle

Rosen, Carly M. ; Ngaage, Ledibabari M. ; Rada, Erin M. ; Slezak, Sheri ; Kavic, Stephen ; Rasko, Yvonne. / Surgical Management of Diastasis Recti : A Systematic Review of Insurance Coverage in the United States. In: Annals of plastic surgery. 2019 ; Vol. 83, No. 4. pp. 475-480.
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