Many procedures of plastic surgery are covered by insurance, where there is a known, attached medical condition. Other cosmetic surgeries that are done for aesthetic reasons only are typically not covered by insurance. The question often arises whether cosmetic or plastic surgery is covered by insurance. Because plastic surgery is an expensive procedure, cost is often a significant factor that can greatly influence a patient’s decision whether they should have the surgery or not. There are many procedures that insurance carriers simply refuse to cover. Eligibility for insurance coverage in plastic surgery can be categorized as either cosmetic or reconstructive. Many cosmetic surgery procedures are undertaken for a variety of reasons other than just aesthetics alone.
Surgery to Improve Function
A plastic surgery procedure might be performed to improve the function of a body part other than for aesthetic reasons. Most of these surgeries are covered by insurance. An example would be an individual who has eyelid surgery (blepharoplasty) as a cosmetic enhancement. While this procedure will not be covered by insurance, during that surgery, the surgeon may correct droopy eyelids that are blocking the patient's vision. This part of the procedure would be covered by insurance.
Partial Insurance Coverage
While breast augmentation performed specifically for aesthetic reasons is not covered by insurance, it could be covered as a part of the recovery process after a mastectomy. Other cosmetic surgeries that might be covered by insurance include:
- Abdominoplasty – The abdominoplasty procedure is typically performed on obese individuals as a way to eliminate or improve health conditions.
- Breast Surgery – Many individuals are eligible for financial coverage and possible insurance coverage if the surgery reduces large breasts that are causing shoulder pain, back pain, and other related issues.
- Ear Surgery – Surgery on the ear might be covered if it is correcting a deformity caused by injury or disease.
- Eyelid Surgery (Blepharoplasty) – This procedure might be covered if the eyelid surgeon is performing the procedure to correct drooping eyelids that are causing significant vision problems.
- Nasal Surgery - This procedure is often performed to correct nasal deformities and birth defects.
It is essential to understand if the cosmetic surgery procedure is eligible for insurance coverage before having it performed. Additionally, it is important to discuss payment methods with your plastic surgeon for procedures that are not covered by insurance. Making the determination of whether plastic surgery is covered by insurance usually comes down to whether it is for reasons other than a corrective method for a significant medical condition. Remember that individual circumstances and health plans widely vary, as does the coverage by various insurance carriers.
