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Plastic Surgery and Insurance

By September 13, 2017 No Comments

Plastic surgery can be an expensive procedure, and many patients wonder how much of the cost their health insurance will cover. The answer is different for each patient, depending on their procedure and type of coverage. But there are some general rules to keep in mind when asking your insurance company about plastic surgery.

Reconstructive vs. Cosmetic Surgery

Insurance companies classify plastic surgery procedures into two main types, based on definitions provided by the AMA (American Medical Association) and ASPS (American Society of Plastic Surgeons):

Reconstructive surgery corrects an abnormal bodily structure to restore normal function. It includes procedures that address congenital defects, developmental abnormalities, disease including infection and tumors, and trauma.
Cosmetic surgery modifies normal bodily structures for aesthetic reasons.

Generally, reconstructive surgery is considered a medical necessity, and insurance companies will help cover the cost. On the other hand, cosmetic surgery is considered a personal choice which most insurance will not cover.

The boundary between reconstructive and cosmetic surgery can be blurry. For example, circumcision was once considered reconstructive surgery, but due to scientific studies and evolving cultural norms, many insurance companies now consider it cosmetic and do not pay for the procedure. Procedures like breast augmentation and liposuction are considered cosmetic and not typically covered by insurance. Many procedures, though, can be either. Here are some examples of procedures that may fall under the definition of reconstructive surgery and receive some coverage:

  • Breast surgery that corrects asymmetry or congenital absence such as tuberous breast correction and capsular contracture treatment (capsulectomy)
  • Breast reduction to reduce chronic back and shoulder pain (reduction mammaplasty)
  • Nasal surgery that corrects a deviated septum or blunt trauma (septoplasty)
  • Facial reconstruction following a traumatic accident or skin cancer
  • Removal of malignant moles and lipomas
  • Scar revision or scar removal to increase daily functioning

And many more. Every insurance company operates differently.

How to Determine If Your Procedure is Covered

Before you commit to a plastic surgery procedure, we highly recommend that you contact your insurance company first to determine your coverage. We can provide you with a detailed cost estimate to compare to your policy coverage. Some details to watch out for:

  • The amount of your deductible
  • The maximum amount payable
  • Whether related medications such as pain killers receive coverage
  • Whether post-procedure care is covered

In some cases, your insurance may be willing to pay for part of the procedure, while you cover the portion that is considered cosmetic. Always get the details in writing so you have concrete facts to guide your decision.

Contact Beverly Hills Plastic Surgery Group with any questions regarding insurance coverage. We will do our best to keep you informed and guide you through the process of interacting with your insurance company.