Will Insurance Cover My Plastic Surgery?
Plastic surgery is categorized into two main categories, reconstructive and cosmetic. Some insurance companies will cover certain plastic surgeries, but they may not cover all types of surgery. Many surgeries are covered because they are deemed medically necessary. Here is more information on when insurance may cover your plastic surgery:
Situations Where Plastic Surgery Is Necessary
Plastic surgery is sometimes performed out of medical necessity, where there’s a functional health issue at hand. When surgery falls into this category, insurance companies may be more likely to cover the costs. Here are some scenarios that may qualify:
- Reconstructive Surgery After Trauma
Injuries resulting from accidents or incidents like burns, fractures, or physical assaults can leave patients with functional impairments or disfigurement. Surgery in these cases is often deemed necessary to restore functionality or improve quality of life. Plastic surgery may include doing skin grafts or repositioning bones and tissue.
- Correcting Birth Defects
Insurance may cover procedures addressing congenital issues, such as cleft lip and palate or ear deformities (like lop ear or cupped ear). These surgeries significantly modify physical appearance to help the patient look more “average.” They can also help improve the normal function of the affected body part.
- Breast Reconstruction After Mastectomy
Health insurance may cover reconstructive surgery for those who’ve undergone a mastectomy due to breast cancer. Laws in many regions mandate that insurers must cover this type of surgery to support physical recovery and emotional health. Breast reconstruction may include making the breasts symmetrical or balanced, doing complete reconstruction, creating prostheses, and correcting physical abnormalities.
- Functional Improvements
Some plastic surgery procedures, while having aesthetic benefits, also address functional issues, such as:
- Blepharoplasty (Eyelid Surgery): This surgery is often performed to improve vision when excess eyelid skin obstructs eyesight.
- Rhinoplasty (Nose Surgery): When performed to correct breathing difficulties caused by structural issues, such as a deviated septum, it can be classified as medically necessary.
How to Determine Your Coverage
If you want or need plastic surgery and believe it may meet the criteria for insurance coverage, here are some steps to take:
- Consult With Your Surgeon: Surgeons can provide documentation outlining the medical necessity of your procedure. This may include details about your medical history, photos, and how the surgery can improve your health or correct functional issues.
- Contact Your Insurance Provider: Every insurance policy is different. Speak directly with your provider to understand what is covered, what documentation they need, and whether there are any pre-authorization requirements. Check your insurance card or the insurance company’s website for the correct contact information.
- Request a Predetermination Letter: If uncertain, ask your surgeon to submit a predetermination letter to your insurance provider. This formal request details why the surgery is necessary and seeks confirmation of coverage.
Talk to Your Insurance Agent and Surgeon
For surgical procedures that serve a functional or health-related purpose, insurance companies may offer coverage, depending on your policy. If you need reconstructive surgery or a cosmetic procedure that is medically necessary, reach out to a plastic surgeon for a consultation. Their guidance can help you make informed choices about your health.