Is plastic surgery ever covered by insurance? The quick answer is yes. One type of surgery may be covered for one person and yet not for another. The most important factor in an insurance company covering plastic surgery is the reason or the cause for the surgery. Are you having a facelift procedure because you want to look younger? Are you having a panniculectomy because of mobility issues and consistent rashes and infections? Each case is different, so let’s break it down.
Enhancement vs. Medically Necessary
Many plastic surgeries can have health and lifestyle benefits beyond aesthetics. Certain procedures like a facelift improve a person’s appearance, but are not considered medically necessary, and would not be covered by insurance.
However, some procedures that are performed for medical reasons can end up with cosmetic benefits. These may be partially or fully paid for by an insurance company.
Breast reduction is another possible procedure that could be covered by insurance. If the reason for surgery is back pain due to excessively large breasts, chronic rashes, or other physical issues, the insurance company might determine the symptoms interfere with daily life. It could therefore be covered or partially covered.
Blepharoplasty is a procedure to remove excess skin from the upper eyelid. It of course improves someone’s appearance which would make it elective. However, if your physician performs a visual field test and determines the upper lid interferes with vision, it may be covered by insurance.
Be aware that every insurance company has different rules and justifiable benefits for insurance coverage. The bottom line is you and your provider must prove your surgery is medically necessary.
- Have photos of your condition.
- Keep details concerning doctor or hospital visits.
- Have tests performed by a doctor and/or a statement from a medical professional suggesting the surgery is medically necessary.
Other Common Plastic Surgeries Deemed Medically Necessary
A number of insurance companies are now paying for weight loss surgery determining chronic obesity is more costly and a risk factor for other conditions.
Breast implant removal can be covered due to rupture of silicone implants or development of a capsular contracture..
Skin removal surgery may be covered because of chronic rashes and infections.
Breast reduction can be covered if there is a history of neck/back pain and/or chronic rash and infections.
Breast augmentation or reconstruction due to mastectomy or breast cancer is now part of the Women’s Health And Cancer Rights Act (WHCRA), and is paid for by insurance.
If You Still Have Out-of-Pocket Expenses
If you must pay for part of, or for all of, a procedure, make a plan.
Save money over time, take out a loan, or ask about financing payment plans.
Always choose a board-certified specialist like Loreen Ali, MD in Chelmsford, MA to perform your plastic surgery.
Contact New England Plastic Surgery Center if you have questions about a plastic surgery procedure. We will be happy to help you determine if all or part of the surgery will be covered by your insurance. Give us a call at (978) 942-4835 today to get started, or request an appointment through our secure online form.
Sources: Cosmetic Surgery Coverage (medicare.gov)
Find out If Insurance Will Cover Your Plastic Surgery (verywellhealth.com)
FAQ’s about Cosmetic Surgery | Penn Medicine
What Types Of Plastic Surgery Procedures Are Covered By Insurance? (vipplasticsurgery.com)