Insurance coverage for plastic surgery varies depending on several factors, such as the type of procedure, the reason for the surgery, and the insurance provider’s policies. In general, cosmetic procedures that are performed solely for aesthetic purposes are typically not covered by insurance. However, there are instances where insurance may cover plastic surgery if it is deemed medically necessary. For example, reconstructive surgeries to correct congenital abnormalities, injuries, or medical conditions may be covered by insurance.
This could include procedures such as breast reconstruction following a mastectomy, correction of birth defects like a cleft lip or palate, or repairing damage from accidents or burns.
Additionally, some insurance plans may offer coverage for certain cosmetic procedures if they are deemed medically necessary for psychological well-being. This often requires documentation from a healthcare provider demonstrating the medical necessity of the procedure.
Which Cosmetic Procedures Are Usually Covered by Insurance?
On the contrary, it is a hard task to state which procedure is covered by health insurance. This is because the purpose of the surgery and the coverage details can differ from case to case. Nevertheless, the determining factor is the reason for the surgery. Here are some of the plastic surgeries that can be covered by insurance:
- Blepharoplasty for vision impairment.
- Reconstructive Breast Surgery – Breast reconstruction after mastectomy for breast cancer or surgery to correct asymmetry.
- Reduction of Mammoplasty for Health Reasons – Health issues like neck pain or back pain.
- Rhinoplasty for breathing issues.
- Skin Removal after Massive Weight Loss.
- Gender-Affirming Surgery.
- Cleft Lip and Palate Repair.
- Hand surgery for functional reasons.
- Reconstruction after trauma or cancer.
- Otoplasty for congenital deformities.
Equally important, you need to know that the medically necessary procedure can differ depending on the insurance company and your policy as well. Therefore, speak to your insurance company to get a better understanding of your coverage.
Which Cosmetic Procedures Are Not Covered By Insurance?
As you know, plastic surgery is a medical procedure that is performed to change or improve the appearance of an individual. However, this procedure is not generally covered by health insurance because it is said to be optional and not medically necessary. Nevertheless, here are some of the common plastic surgery procedures that are not normally covered by insurance:
- Liposuction
- Buttock Augmentation
- Gynecomastia Surgery
- Rhytidectomy (Facelifts)
- Rhinoplast
- Hair Transplantation
- Abdominoplasty (tummy tucks)
- Cosmetic dental procedures
- Breast Augmentation
- Blepharoplasty (eyelid surgery)
Moreover, it is crucial that you understand the difference between reconstructive and cosmetic surgery.
Why is Cosmetic Surgery Not Covered by Insurance?
As mentioned earlier, cosmetic surgery or plastic surgery is not usually covered by insurance because it is considered not medically necessary and elective.
On the other hand, health insurance is arranged to offer coverage for necessary or important medical procedures that will treat injury or illness or improve the policyholder’s health.
How to Get My Plastic Surgery Covered by Insurance
In the final analysis, the question of whether or not your insurance policy covers plastic or cosmetic surgery depends on your insurance company or provider.
Although this may or may not work in your favor, there is still something you can do to help yourself. Here are some steps that you can take if you want to be considered for coverage:
- Take note of your condition with logs, photos, or by visiting your doctor.
- Keep records of your trip to the doctor or hospital related to your condition. Therapies and purchased products are a great way to start.
- Get statements from your health specialist, doctor, or other medical professionals suggesting that your choice of surgery should be performed for medical purposes.
- Provide evidence that all your options to treat your condition have been exhausted and that surgery is your only hope.
Lastly, you can choose a well-known and qualified plastic surgeon and a prominent surgery center to be responsible for your care.
Conclusion
Whether or not an insurance policy covers plastic surgery depends on certain factors. As an illustration, consider the specifics of the insurance policy and the purpose of the surgery. It is important for policyholders or individuals who are contemplating plastic surgery to speak to their healthcare provider as well as the insurance company. This will help them understand the necessary things that are considered medically necessary and what their policy will cover.
