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Will Insurance Cover the Cost of My Plastic Surgery?

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Updated April 09, 2014

Question: Will Insurance Cover the Cost of My Plastic Surgery?
Answer:

Many people want to know if their health insurance will cover the cost of their plastic surgery procedure. The answer is sometimes yes, but more often, no.

Insurance will cover the cost of some procedures if they are considered reconstructive (as opposed to purely cosmetic) in nature. For example, breast reconstruction after mastectomy is covered, and this coverage is now actually required by law. A breast reduction may also be covered in cases where the patient experiences moderate to severe chronic pain as a result of having very large breasts. In addition, some reconstruction of cosmetic defects following an accident may be covered under certain plans, and repair of certain birth defects, such as cleft palate, are often covered as well.

Moreover, the surgical correction of any cosmetic defect which significantly impacts function of the body part in question may also be covered. One example is a severely hooded eyelid that partially obscures a patient's vision. If such a patient decides to undergo blepharoplasty, the procedure may be covered at least in part by insurance.

There also may be partial coverage available for any portion of an operation that is not considered cosmetic. A perfect example of this is the correction of a deviated septum within a rhinoplasty (nose job) procedure. Since a deviated septum can negatively affect a patient's breathing and contribute to increased incidence of infection, the correction would likely be covered. However, the part of the surgery which seeks to correct cosmetic aspects of the appearance of the nose would not be covered.

In short, if the purpose of your surgery is intended only to improve your appearance, it is almost certainly not a covered expense. If, on the other hand, the procedure will correct or improve a legitimate medical concern, it may be covered in part or in full.

Health plans and individual circumstances vary widely. If you think there is a chance your procedure may be covered, you will need to speak with both your surgeon and your insurance company to confirm your hunch. Only they can tell you if your planned procedure qualifies for full or partial coverage by your insurance plan. Also keep in mind that your plan may include special co-pays or deductibles which apply specifically to these types of procedures. It is important to note that even when coverage is provided for reconstructive procedures, there is usually some sort of pre-certification required, so be sure to do your homework before scheduling your procedure.

Source:

Insurance Coverage: A Patient's Guide. Consumer Information Sheet. American Society of Plastic Surgeons http://www.plasticsurgery.org/patients_consumers/planning_surgery/insurance_coverage.cfm

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