Does Insurance Cover Plastic Surgery?

When it comes to cosmetic enhancement, plastic surgery is one of the more expensive options. Even though the long-term payoff is significantly greater than the financial expense, the costs for plastic surgery can add up. In some cases, insurance will cover all or a portion of the cost for plastic surgery, as long as you and your doctor provide documentation proving medical necessity. 

 

What defines medically necessary plastic surgery? 

Every insurance plan has different rules and regulations around what they’ll cover and what they won’t, but in general, procedures are deemed medically necessary when they improve the functioning of a body part, relieve painful symptoms, correct the result of an injury, reconstruct the breast following a mastectomy, or treat congenital defects. When a procedure is done purely for cosmetic purposes, most insurance plans will not cover any portion and the total cost must come out of pocket. When the insurance carrier considers a procedure medically necessary, they may cover all or most of it. When cosmetic procedures are combined with functional procedures, the insurance plan will typically cover only the portion that is considered medically necessary. The rest will come out of pocket. 

 

Examples of plastic surgery covered by insurance

The best way to determine your insurance coverage is to contact your carrier and ask directly. In the meantime, here are some examples of plastic surgery that would typically be covered by insurance. 

• Eyelid surgery – Blepharoplasty may be considered medically necessary when excess tissue from the upper eyelid causes functional visual impairment.
• Breast reduction surgery – Reduction mammoplasty may be considered medically necessary when it’s associated with persistent symptoms such as neck pain, headaches, shoulder pain, or other pain that has not been relieved through more conservative measures.
• Breast reconstructive surgery – When used to repair breast asymmetry due to a medically necessary lumpectomy or mastectomy, breast reconstructive surgery is typically considered medically necessary.
• Nose job – Septoplasty is considered medically necessary when used to correct recurrent sinusitis due to a deviated septum. Rhinoplasty is considered medically necessary when used to correct nasal airway obstruction where conservative management techniques have not been sufficiently effective.
• Skin removal – Panniculectomy may be considered medically necessary if the excess skin left behind after significant weight loss causes frequent rashes, skin irritation, or infections.

The above examples are just a small handful of the types of plastic surgeries that may be considered medically necessary and therefore covered by insurance. Although they are all different surgeries, one thing they have in common is that they serve to improve functioning or relieve painful symptoms. In many cases, they also result in an enhanced appearance. 

 

Make the most of your medically necessary procedure

If you’re planning to undergo a plastic surgery procedure that has been deemed medically necessary by your insurance carrier, it could be a good time to combine it with a cosmetic procedure that you’ve always wanted. For example, if you have a rhinoplasty scheduled to correct breathing problems, you may want to consider additional changes to correct nostril asymmetry or modify the nasal tip. Although this won’t change your insurance coverage (you’ll still have to pay out of pocket for the additional cosmetic procedure), combining the two may significantly reduce the cost of your cosmetic procedure. Depending on your surgeon’s policies, you may be able to avoid paying twice for anesthesiology and operating room fees. Additionally, by recovering from both procedures at once, you’ll save time as well.

 

Functional, reconstructive, and cosmetic plastic surgery in San Diego | Feel Beautiful

Whether you’re looking for functional, reconstructive, or cosmetic plastic surgery, Dr. Laverson can help. As a Board Certified plastic surgeon for more than 23 years, Dr. Laverson’s precision, skill, and artistry have helped thousands improve their health, enhance their appearance, and boost their confidence.  Call Feel Beautiful at (858) 295-4001 to schedule an appointment with Dr. Laverson today.