Insurance Cover Your Cosmetic Surgery Procedures?

Getting a cosmetic surgery is expensive, so it makes sense to wonder if your health insurance is going to cover the procedure before you schedule an appointment with a renowned cosmetic surgeon. Unless you have been saving money for years before your procedure, you will want to know if your insurance company will be willing to pay for it before you go under the knife.

The answer depends on the type of health insurance you have.

Can your insurance policy cover your next cosmetic surgery procedure? There is no definitive answer to this question. You can probably expect to have to pay for your cosmetic surgery yourself, but it depends on your insurance company, and on the type of health insurance policy you have. Some insurance companies will pay for certain types of cosmetic surgery procedures, while others will not.

It also depends on the type of surgery you are considering 

Whether or not your health insurance will cover your cosmetic surgery mostly depends on which type of surgery you will be getting. As a general rule, insurance companies only pay for surgeries that they consider necessary for the health of their insured customers.
If the surgery you are considering is considered reconstructive instead of cosmetic, there is a higher chance it will be covered by your insurance policy.

What is considered reconstructive surgery? 

Surgeries that are meant to correct abnormalities caused by congenital defects, disease, tumors, infection, or trauma, are considered to be reconstructive and are generally covered by insurance companies. The goal of a reconstructive surgery is to improve function or restore a normal appearance.

What is considered cosmetic surgery? 

On the other hand, the goal of a cosmetic surgery is to improve the appearance or the self-esteem of a patient by reshaping a normal structure of the body. Since these surgeries are not necessary to the overall health of the patient, they are not covered by insurance companies most of the time.

Examples of cosmetic surgeries that are usually not covered by insurance 

If you were thinking about getting a liposuction, a breast augmentation, or an eyelid surgery, there is a good chance that your insurance policy will not cover it if your insurance company determines that this procedure isn't necessary to maintain your quality of life.
However, partial coverage is possible if you are getting a cosmetic surgery that will also improve your quality of life or your overall health.

Exceptions 

In some situations, a surgery might be considered cosmetic and reconstructive at the same time. For example, if a woman is getting a breast reduction because her large breasts are causing her chronic back pain, her insurance company might be ready to cover the procedure.
In the same way, a nose job might be considered necessary for someone who can't breathe normally because of a deviated septum, or an eyelid surgery might be necessary for someone who can't see properly because of excess skin around the eyes.

How to figure out if your surgery will be covered by your insurance 

If you are unsure whether your cosmetic surgery will be covered or not, you will have to figure it out before your procedure.
You should start by getting a detailed estimate for the cost of the procedure you are considering. You should then contact your insurance company to find out if your procedure is covered, partially covered, or simply not covered by your policy.

If a full or partial coverage is possible, your estimate will be useful in helping you figure out what will be covered.



Plastic Surgery and Insurance Coverage - Everything You Need To Know

“Will insurance cover my plastic surgery?”—that’s a great question

If you’re going to invest in plastic surgery, you want to make sure you’re not paying for something your insurance covers. Plastic surgery and insurance coverage are a bit tricky—there’s always gray areas and thin lines.

Here’s everything you need to know:
Most insurance doesn’t cover any type of cosmetic surgery procedures.
Companies also make clear distinctions between plastic surgery that’s done for cosmetic purposes and plastic surgery that’s done to:

  • Reconstruct parts of the face
  • Preserve quality of life
  • Restore normal function

Surgery done for these reasons might be covered by your insurance.

Cosmetic Surgery That Won't Be Covered by Your Insurance

The three most common procedures that aren’t covered by insurance are:

  • Liposuction
  • Breast augmentation
  • Eyelid surgery

These surgeries are considered “optional” and insurance companies will not cover them unless rare circumstances dictate.

Plastic Surgery That Might Be Covered

As previously eluded to, plastic surgery that’s done to preserve function and health can be covered by insurance. Your surgeon’s diagnosis will be looked at by your insurance company. Insurance companies will first determine if non-surgical measures can be taken. If they can’t, coverage might be possible.

It’s important to know that there never are guarantees. Each company has its own rules, restrictions, guidelines, etc. Never get a surgery before you know if it will be covered by insurance, as payments after surgery will be impossible.

Situations Where You Might Be Covered

Insurance companies place a lot of emphasis on the reasoning behind a procedure. Coverage is possible if you have a problem due to:

  • A car accident
  • A major accident
  • A burn incident
  • Injuries sustained during an altercation that you had no control over

Insurance companies view these situations are “non-optional” reasons to have a procedure. Your chances of being covered are high.

An Example of a Situation Where You Have a Good Chance of Being Covered

You sustained an injury to your nose. The injury causes you to not breathe properly and gets in the way of your day to day life. Your surgeon diagnoses you with a deviated septum and says that a nose job can be done to correct it.

In this (or a similar) situation, your chances of being covered are high.

Conclusion -- Your Surgeoun is Your Best Resource

For information regarding insurance coverage of the specific procedure you’re interested in, it’s always best to seek the advice of a board certified plastic surgeon. They can diagnose your condition and then give you the information you need in regards to coverage. Their experience is unprecedented—if you can get coverage, they will know how.


Should insurance cover cosmetic surgery?

hould insurance cover breast augmentation, the procedure commonly known as a boob job?

Most people would say “no, of course not.” That’s a cosmetic procedure, and health insurance shouldn’t pay for a procedure done to make someone look better. But what if it is part of breast reconstruction after breast cancer surgery, or part of gender reassignment surgery for a transgender patient?

That’s different, they might say.

Sometimes there’s a fine line between a cosmetic procedure and a medically necessary one. As a society, we have decided that most cosmetic procedures are elective and thus should be paid for by the individuals having them, while medically necessary procedures are covered by insurance. This makes it difficult for people who want to have surgery for conditions that fall in the gray zone between cosmetic and medically necessary, difficult for the doctors who take care of them, and a challenge for insurers whose goal is to minimize their expenses.

At the core of this issue is how we define the terms cosmetic and medically necessary. The traditional distinction is that cosmetic treatments are merely enhancements that improve appearance, while medically necessary treatments address a disease and are necessary for health or survival. But this distinction can be arbitrary.

Further complicating matters is the role that health care plays in our lives. One important role, to be sure, is to preserve and extend people’s lives or, in the language of medicine, to reduce mortality and morbidity. Those outcomes are relatively easy to measure. But health care should also strive to improve something that’s less easily defined: quality of life. Most people live long lives these days but many of them also develop chronic health problems, despite the pace of medical advances. We are living longer than ever, but not necessarily better.

Here’s a common example from my dermatology clinic. A patient waits months for an appointment. When I finally see her, she points out a skin tag in her right armpit. This benign, polyp-like growth has bothered her for years — she often nicks it while shaving, it rubs against her clothes, and it occasionally becomes painful and irritated.

After I examine the patient and her skin tag, I am confident that it is not a type of cancer and does not threaten her health or life. But that doesn’t solve the problem. Here’s my dilemma as her doctor: If I remove the skin tag to improve her quality of life, she will almost certainly have to pay for the procedure because her insurance company will deem it cosmetic. But if I remove the skin tag and then send it to a pathologist to evaluate, her insurance will pick up the cost because the removal can be justified as necessary to prove it wasn’t skin cancer.

I find it ironic that performing an extra evaluation (at extra cost) to confirm that the skin tag was benign adds credibility to my claim that its removal was medically necessary. At what point does performing a biopsy of tissue that is conspicuously normal, in the service of taking care of patients, become fraud?

Nothing is 100 percent in science or medicine. I don’t want to miss a skin cancer, and though it’s rare, I’ve seen normal-looking skin lesions turn out to be cancers. This could give me license to biopsy everything, but that approach isn’t cost-effective and ignores the complications that biopsies can cause, such as scars, infected wounds, and the like. But as I strive to provide excellent care to my patients, I must often advise them against treatment for conditions that mainly affect their quality of life unless they can pay for it out of pocket.

More and more I find myself arguing with insurance companies to cover treatment of my patients’ skin conditions that are seriously affecting their quality of life. I fill out countless prior authorization forms and regularly talk peer to peer with medical representatives, advocating for my patients. In addition to irritated skin tags, insurers also often don’t want to pay for steroid injection treatments for the painful overgrowing scars known as keloids, for the autoimmune hair loss known as alopecia areata, and even for painful cysts that form in the underarms or folds in the skin (hidradenitis suppurativa). These conditions and others can deeply affect an individual’s quality of life. Yet I am frequently told that I have not sufficiently proven that.

To be clear, I don’t believe that health insurance companies should give patients carte blanche to have any and all cosmetic concerns treated and to have the costs shared by others in the insurance pool. It’s entirely reasonable to create a set of priorities for how we spend our health care dollars. However, I think insurance companies’ priorities on what they will pay for do not necessarily match what can make real differences in people’s lives.

Our health care system spends a disproportionate amount of money taking care of patients during their last months of life. In one study, 30 percent of Medicare dollars were spent on the 5 percent of people who died in a year, with another study showing one-third of the expenditures in the last year of life being made during the last month.

I do not want to minimize the importance of end-of-life care, and it may not be entirely clear that the end of life is near when that money is being spent. But from a purely utilitarian perspective, does it make the most sense to be spending so much money on end-of-life care and so much less on actively improving the quality of life of those with decades left?

It is impossible to value one person’s life over another’s, nor should we try to do that. But I think that we must not undervalue the importance of addressing conditions that affect quality of life.

There is a growing body of evidence that treatment of supposed “cosmetic” concerns can have a real and positive effect upon quality of life. Facial cosmetic surgery, for example, has been associated with modest improvements in quality of life, self-esteem, and body image. In addition, better quality of life is likely to improve patient satisfaction, which is increasingly (if controversially) being used to measure the value of health care.

While lifesaving treatments are always a priority, I believe that doctors today should also try to improve their patients’ quality of life, and measures that do that should be paid for by insurance. Placing more value upon quality of life and working to preserve it should be paramount, and valuing patient complaints that some may dismiss as merely “cosmetic” is among the first steps to address this.

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