Which cosmetic surgery procedures are covered by your health insurance?
Jun 27, 2012, 8:13 a.m.
In most cases, insurance for cosmetic surgery is not available for elective procedures. Insurance companies maintain that, since these procedures are unnecessary, there is no basis for covering cosmetic surgery costs.
The key to having insurance for cosmetic surgery lies in one word: Reconstructive . Some cosmetic surgery costs are covered if medical professionals classify procedures as reconstructive and not elective for body enhancement. Here are some of the more common examples of plastic surgery that may qualify as "covered" under many health insurance policies.
Abdominoplasty, commonly called a "tummy tuck," is often covered by insurance for cosmetic surgery when the medical community determines that an obese patient may face dangerous heart disease or other potential life-threatening health problems. This procedure is often covered as it is reconstructive in nature and recommended for worthy health reasons.
Another fairly common example of cosmetic surgery costs eligible for coverage is a breast reduction procedure. While augmentation is almost always deemed to be elective plastic surgery, and not covered, reduction is often medically necessary to reduce or eliminate orthopedic pain (usually in the patient's back).
The "fine line" between elective and reconstructive surgery is also evident when considering eye-related procedures. For example, eyelid surgery is worthy of note. Should you choose to have this procedure to aesthetically enhance your appearance, cosmetic surgery costs are seldom covered by health insurance. However, if the procedure is to eliminate "drooping" eyelids, which often hurt patients' vision, this surgery may be covered.
Insurance company general rules apply to rhinoplasty, often called a "nose job," as well. Should medical professionals recommend this surgery to remove breathing obstructions, it is often a covered procedure. As you might expect, however, if you decide your nose needs improvement to enhance your looks, there is no insurance for cosmetic surgery for this procedure.
Be aware, however, that even cosmetic surgery costs for good medical reasons may not be fully covered. Your health insurance plan dictates the level of coverage you enjoy (or not). Examine your policy to learn of a) annual or procedure deductibles, and b) the percentage of reimbursement in your plan, e.g., 80 percent paid by insurance carrier, 20 percent paid by patient.
If you also have coverage for prescription medications, find out if the specific meds your surgeon will prescribe are covered under your drug plan. Should they be excluded, ask your doctor if there are acceptable alternative medication options that are covered under your health plan.
When you contemplate cosmetic surgery for medical reasons, analyze your insurance for cosmetic surgery policy language to learn if the procedure is covered. Also, examine the requirements you must satisfy to permit your carrier to pay most or all of your cosmetic surgery costs. Depending on your plan requirements, you can advise your surgeon of the documentation your insurance carrier wants to justify the medical reasons for the procedure.
Almost all insurance companies employ the same general rule. If the cosmetic surgery is "your choice" to enhance your appearance, there is no coverage. Should a qualified medical professional determine a procedure is necessary, in most cases your cosmetic surgery costs are covered. However, should you choose to have cosmetic surgery to improve your chances of a new modeling career, take out your checkbook.
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