Huge win for mums: Abdominal repair surgery to be covered by Medicare

covered by Medicare

After a lengthy campaign by mothers and surgeons, the MSAC (Medical Services Advisory Committee) now recommends that abdominal repair surgery for postpartum women should be covered by Medicare.

This is a huge win for Australian women who suffer from conditions such as diastasis recti, or abdominal separation, where the connective tissue in between the long abdominal muscles stretch during pregnancy to allow for the baby to grow, causing the abdominal muscles to separate permanently.

The condition affects mainly women over 35 in the second and third trimesters of pregnancy, and according to a study done in Norway in 2016, around a third of all women develop this condition after they’ve given birth. Abdominal separation can leave a ‘gap’ between the muscles of more than two centimetres. The area can also ‘cone’ or appear to bulge through the midsection, bringing with it pain, pelvic floor muscle dysfunction, and lack of muscle control.

It all began with one mother

While there are plenty of physical therapies available, not all of these can resolve more severe cases of the condition. One such case is Kerrie Edwards, a mother of twins. After finding herself unable to lift her twins or participate in regular exercise, she initiated a petition that was signed by 13,000 people and tabled in the House of Representatives by Dr. Fiona Martin MP, on behalf of many thousands of mothers. This helped persuade MSAC of the value of the surgery.

“I am delighted with this decision” said Kerrie in a press release. “This will make an enormous difference to so many women who currently cannot lift their children without pain; cannot participate in sport or exercise; or who are finding it difficult to return to the workforce.”

What does the surgery involve?

Abdominoplasty surgery involves sewing back together abdominal muscles that have been separated during pregnancy. This surgery was removed from the MBS (Medicare Benefits Schedule) in 2016 due to concerns it was being misused for cosmetic surgery, rather than medically-necessary reasons. Cosmetic surgeries are not covered by Medicare.

Without a Medicare item number, private health insurance would not cover costs associated with the abdominal repair, leaving many women unable to have the surgery or facing costs between $15,000 and $20,000 for the procedure.

This impacted thousands of postpartum Australian women suffering chronic back pain, and in some cases, incontinence that failed to resolve with conservative treatment such as physiotherapy or pilates.

The problem with calling it a ‘tummy tuck’

“Because this procedure has been commonly described as a ‘tummy tuck’, many people assume that it is always purely a cosmetic procedure and find it difficult to believe it might be for a legitimate functional reason,” said Australian Society of Plastic Surgeons President, Dr Dan Kennedy.

But that will change from later next year when the reconstructive, correctional surgery will be funded by Medicare after it was removed in 2016.

Women and their surgeons will need to demonstrate the patient’s procedure is medically necessary and that non-surgical options such as physiotherapy have been tried first. Meeting these criteria will be necessary to be eligible for coverage.

 

Asad Saimon
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