Question: Since plastic surgery is almost always elective, do insurance companies ever pay for it?
Answer: In a perfect world we would all be able to make the changes we would like and have it covered by our insurance programs. Unfortunately, that isn’t always the case. However, because plastic surgery encompasses both reconstructive surgery and cosmetic surgery, insurance will often pay for more procedures than you might expect. Most surgeries that are recommended to improve function, to correct a defect from birth, disease, or injury, or to prevent disease are usually covered by health insurance. Some of the following are examples of surgeries commonly insured:
• Breast Cancer Reconstruction, which also includes surgery on the breast opposite the breast cancer in order to obtain symmetry.
Breast Reduction Surgery, which would require that a specific amount of breast tissue be removed, in order for insurance to consider it medically necessary.
Reconstructive Breast Surgery to correct a birth anomaly, or malformation.
Nasal Surgery, for the improvement of breathing.
Skin Cancer Surgery and the surgical repair of the tissue after removal of the cancer.
Removal of suspicious or premalignant moles (nevi) on the skin.
Upper Eyelid Surgery, if the eyelids are shown to cause obstruction of vision.
Procedures that enhance appearance, if not related to birth defects, cancer treatment or injury, anything that isn’t considered “medically necessary†are unlikely to be covered by insurance companies.
Procedures that are generally not covered include: liposuction, breast augmentation (enhancement); tummy tucks; facelifts, cosmetic nasal surgery, cosmetic eyelid surgery, breast lifts (mastopexy); cosmetic hair transplantation, and injectables such as Botox, Juvederm, and Restylane.
There are many gray areas where cosmetic surgery and reconstructive surgery can overlap. When insurance does not cover a procedure, most offices will offer financing through a third party if you still are interested.
It is advisable for you to make sure that your insurance company will pay for a procedure and have written documentation to prove this prior to having any procedure. There are a few disreputable practices out there that may tell you something is covered by insurance but without documentation to verify this, you could be left with a physician’s fee and, if surgery is performed, operating room and anesthesia bills from the hospital as well. It is best to seek the advice of a reputable board certified surgeon who can assist you with your inquiry.
