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Medically unnecessary - repair of Diastasis recti

by TL
(Woodbridge VA)

I wanted to second the comments about the necessity of this repair with regard to chronic lower back pain. It angers me that insurance companies will pay for repeated chiropractic and acupuncture sessions, knee braces, PT, but not to have this repair done, in most cases.

I suffered from lower back pain for 20 years, on and off, following the birth of a very large baby at a very young age. I knew my core muscles were in bad shape, but the insurance companies had denied the repair several times over the years. They continued to pay for treatment for lower back pain, however. finally convinced an insurance company to pay for an abdominoplasty about 3 years ago. They repaired 3 small hernias as well as the diastasis recti. The lower back pain continued, however. I also began having pain in one knee.

Recently I started working with a personal trainer who is well versed in physical therapy and muscle movement. I learned that years of not being able to use my abdominal muscles to stabilize my balance has caused me to adapt my movements to rely on other muscle groups, and out of alignment movements were over stressing these groups and causing pain. The surgical repair alone was not enough - I'm now re-learning how to carry my body in alignment, and move correctly. The lower back pain is a rare occurrence and the chronic knee pain is a thing of the past. But, I'm undoing 25 years of moving incorrectly. It requires a lot of work and supervision by someone who knows how my body is supposed to move. I'm very thankful to know now what I know, but sorry all those years were wasted.

Comments for Medically unnecessary - repair of Diastasis recti

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Diastasis of abdominals - repair should be covered by insurance
by: Marlene

I have had two kids. My DR is getting worse and worse. I have always been very athletic and fit. I haven't been able to run or do most lower body weight training for many years now. I have extreme pain in my lower back and glute and ham. I can't do abdominal exercises. It causes severe abdominal (deep inside) pain. I have severe constipation which I medicate daily, intestinal cramps, can feel my aorta and intestines pulsating and parastalsing through my abdomen. My lower belly bulge increases with time. I am 38 years old. Help?

Kaiser will not pay for repair
by: Penny

I just had a consult with a PS at Kaiser Northern California.
For 20 years I have had back pain, and yeast infections. A regular surgeon told me I need a diastasis recti repair. The PS did not understand my back pain, and thought I am controlling the yeast infection with an RX for medicated powder. I have been dealing with this for 21 years. Three years ago I lost 100 pounds and really, really want this repair. How can I get my insurance to pay for this?

Any advice would be welcome!

Can someone help me
by: Laura

I had a lysis of adhesions surgery in 12-07 and after three months I moved a light piece of furniture and felt like a separation underneath my belly button.After this I became weaker and weaker. I had difficulty walking, standing, sitting, and had to stop working and hire someone to care for my small children. The surgeon told me I have diastasis recti and if I overdo it I will go backwards. It took eight months to regain my strength and then I lifted something and it came back. i had two MRIs they show nothing. I was checked out that I don't have a hernia. Does this sound like severe diastasis recti? I also am in a lot of pain. I am petrified of surgery any ideas out there for me? Thank you I can be reached at fivestarairinc@hotmail.com

Additional comment on the long term effects
by: TL

Hi again

Recently, I have begun doing yoga and pilates after two years of weight machines and elliptical left me strong but inflexible. I am reminded yet again that years of having diastasis recti has severely weakened many muscles in my body, as I have adapted movements to work around not having abdominal support and any kind of a "core". There are many movements that I do easily, and some very basic things that I cannot do - squats and knee bends - sitting on the floor with my knees bent and my feet together - and those are such core movements to any exercise program. The squats, I just don't get how to lean back as if to sit without sitting as I have had to basically drop into a chair for a lot of years with nothing to catch me. The sitting pose, I had too much extra skin on my belly to sit that way before. The hip flexor muscles have issues. It is extremely discouraging but I do know what the problem is and as long as I can get into the right position, I will eventually build them back up. I never would have known about these weaknesses if I had not had the repair done. I think the squats are going to be the toughest, my knees are beginning to be a problem and the miss-positioning really hurts. I wish someone could show me how to do it right, hands on. I think I'll have to work one on one with the trainers for this.

How did I get Insurance Co to cover abdominoplasty?
by: TL

Hi Tina

Thanks for your question. The insurance company originally denied the procedure and I requested an outside review, which means that they send the records to a surgeon not on their staff (but who surely gets a stipend for their work)and ask their opinion. I had loose, hanging skin that had abscessed at the fold earlier in the year and required a series of antibiotics to heal (sorry so graphic) The insurance requirements were that the skin hang below the pubic bone. Mine was right at the line. The outside opinion of the Dr. was that the surgery was medically necessary. I also got a letter from my primary care physician who treated the abscess, she supported my cause. It still seems incredible to me that they would cover the procedure for a skin condition, but not because I was unable to use my body properly as a result of the muscle weakness. Good luck to you.

How to talk to the insurance
by: Tina

Just wanted to know how you convinced the insurance to pay for the repair. I have had this condition after 3 kids with C-sections. I am having pain both in my stomach and by back. I cannot exercise my stomach. The bulge is getting bigger. I have gone to two doctors, both saying it is not surgical. Just looking to be pointed in the right direction.


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