Surgical Management of Diastasis Recti: A Systematic Review of Insurance Coverage in the United States
Carly M. Rosen1,2, Ledibabari M. Ngaage, MA Cantab MB BChir2, Erin Rada, MD2, Sheri Slezak, MD2, Stephen Kavic, MD3, Yvonne Rasko, MD2.
1University of Maryland School of Medicine, Baltimore, MD, USA, 2University of Maryland Medical Center Division of Plastic Surgery, Baltimore, MD, USA, 3University of Maryland Medical Center Department of Surgery, Baltimore, MD, USA.
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 corrective surgery despite showing improved function and quality of life following the procedure. Plastic surgeons are frustrated by the lack of guidelines and sparsity of coverage for surgical correction of Diastasis Recti.
Methods: 54 US insurance companies and Medicare were reviewed to determine their policies of coverage. These policies were compared to 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. 78% (40) of these companies would not cover abdominoplasty to repair DR under any circumstances. The remaining 22% (11) required preauthorization to ensure that the patient met the requirements of medical necessity. These requirements differed greatly between companies.
Conclusion: 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 (CPT) coding classifies abdominoplasty to repair DR solely as a cosmetic procedure. Policies for diastasis recti repair should be amended to include a functional procedure reimbursement for severe DR. We include a detailed summary of preauthorization requirements for DR repair requested by insurers to simplify the reimbursement process.
Keywords: diastasis recti; insurance; abdominoplasty; cosmetic procedure; medical policy
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