Does Insurance Cover the Cost of My Plastic Surgery?

More often than not you must pay out of pocket

Hand holding up silicone implant during surgery
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Does insurance cover the cost of my plastic surgery? Whether you're having a cosmetic or reconstructive procedure, you likely want to know the answer to this question. While the answer is sometimes yes, more often it is no, even if the surgery is related to your health.

Coverage for Reconstructive Procedures

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 that significantly impacts the 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.

Possible Partial Coverage

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 designed to correct cosmetic aspects of the nose's appearance would not be covered.

Bottom Line

As a rule, 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, speak with both your surgeon and your insurance company to confirm. 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.

You may have to save up for the procedure, take out a loan, or put some of the cost on a credit card. The IRS allows some medical expenses to be listed on your taxes. Find out if this applies to your surgery.

Source

Insurance Coverage: A Patient's Guide. Consumer Information Sheet. American Society of Plastic Surgeons http://www.plasticsurgery.org/patient-safety/patient-and-consumer-information.html

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