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Does Insurance Cover Plastic Surgery?

Does insurance cover plastic surgery? Yes, your health insurance policy might cover your plastic surgery procedure when the surgery will be categorized as a non-cosmetic surgery. However, there will be certain terms and conditions.

When Does A Health Insurance Cover Plastic Surgery?

Many things will depend on the type of health insurance you have and your insurance company. There are a few factors that you need to consider in order to know that your plastic surgery is covered by your own insurance or not. It is important to know if the surgery is cosmetic, reconstructive, or to preserve the quality of your life. The type of surgery that you’ll have will decide the coverage that you’ll receive.

Coverage might be different for a facelift compared to a someone who is recovering from labor and is in need of a mommy makeover.

Most of the companies follow MMA (American Medical Association) and ASPS (American Society of Plastic Surgeons) definitions. These definitions state the following:

Reconstructive Surgery

Reconstructive surgery means that these surgeries performed are to correct the abnormalities caused by developmental abnormalities, congenital defects, infection, trauma, and disease. These surgeries can help to improve the functionalities or can correct abnormalities to offer a normal appearance.

Cosmetic Surgery

Cosmetic surgery is related to reshaping any normal structure on the body for improving the self-esteem or appearance of the patient. When getting any sort of cosmetic surgery procedure done, be sure to do your prior research and choose a qualified plastic surgeon.

Health Insurance Companies Will Have the Final Say

The health insurance companies will have the freedom to evaluate the condition. They may evaluate differently depending on their policies. They are the final interpreters. Different companies might take things different differently. An example of how these insurance companies might interpret procedures differently is the procedure of circumcision of infants. While some companies cover this procedure, others do not since they find it cosmetic.

The Difference Between Medical Necessity & Cosmetics

This is up to the insurance companies to decide what is medically necessary and what will come under the category of cosmetics. In fact, they can change their policies from time to time depending on the following:

  • Insurance type
  • How they relate to the needs of the patients
  • Evolution of the new procedures
  • Requirements for medical treatment

Surgeries Mostly Covered By Your Insurance

There are many types of surgeries covered by your home insurance. In fact, you might consider them cosmetic surgeries. But, they will be covered by your insurance. Here are a few examples:

  • Abdominal Surgery: When the surgery is performed to improve your health problems including a hernia, sores, back pain, and your walkability.
  • Eyelid Surgery: If it is done to correct vision problems or to improve drooping eyelids.
  • Breast Surgery: When the surgery is performed to minimize the size of breast that causes health complication, congenital absence or to reduce the size of male breasts. In the case where a breast reduction is needed, the 1998 Federal Breast Reconstruction Law, and sometimes referred to as the Women’s Health and Cancer Rights Act of 1998 requires insurance companies to provide coverage for breast reconstructions after a mastectomy.
  • Facial Surgery: If it is done to boost the appearance caused by threat deformities in the head and neck or paralysis.
  • Ear Surgery: When done to correct deformed ears by diseases, injury, or birth.
  • Nasal Surgery: If performed to correct the abnormalities resulting from disease or birth causing breathing problems.
  • Hand Surgery: When done to treat nerve injuries, fused fingers, carpal tunnel syndrome, and similar conditions.

In Conclusion

Does insurance cover plastic surgery? Yes, if you meet any of the above conditions, your surgery might be covered by your own insurance. Most surgeries that are covered by insurance companies include abdominal surgery, eyelid surgery, breast surgery, facial surgery, ear surgery, nasal surgery, and hand surgery.

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