One of the great truths about cosmetic surgery is this: Insurance typically doesn’t cover the procedures. Health insurance is meant to provide protection and coverage for medically necessary treatments. For the most part, cosmetic surgery isn’t medically necessary.
But not all types of cosmetic surgery are the same. Some procedures do have a medical benefit, not just a cosmetic one. In cases where the procedure will somehow improve your health and well being, not just your appearance, insurance may cover some or all of the treatment.
The thing to know is what type of procedures could be covered and why. If it turns out that a procedure you were considering could be covered by your healthcare plan, it’s important to check with the company that runs your plan before scheduling it. Here are a few examples of surgeries that could be covered.
Rhinoplasty
Your insurance company isn’t going to pay up for rhinoplasty that only provides a cosmetic benefit, such as reducing the size of your nose or adjusting the angle of the nasal tip. But if you need rhinoplasty because you have trouble breathing through the nose or if your surgeon recommends rhinoplasty in addition to septoplasty to improve your nose’s overall function, your healthcare plan might cover it.
Insurance might also cover surgery that corrects a deformity in the nose that occurred after a sports accident or a car accident. If you are having both a functional rhinoplasty performed and cosmetic changes made, your policy will potentially pay for the functional portion of the procedure. You would be responsible for the cost of the cosmetic portion.
Breast Reduction
Although some women want larger breasts, plenty of women with naturally large breasts wish they were smaller. Large breasts not only make it difficult to find bras and clothing in the right size, they can also cause considerable back and shoulder pain. For that reason, some insurance policies provide coverage for breast reduction surgery.
To qualify for coverage, the surgery needs to be performed as a way to alleviate the pain. Usually, a considerable amount of tissue needs to be removed for insurance plans to even consider covering the procedure. Also, many plans will encourage patients to try other pain reduction options first, such as seeing a chiropractor or trying physical therapy.
Your insurance company might not make it easy for you to get coverage for breast reduction. But if you can show that other treatments haven’t helped and that surgery is your best option, your plan might cover some or all of the costs.
Eyelid Surgery
Blepharoplasty, or eyelid surgery, is often performed for purely cosmetic reasons. The surgery can help you look younger by making your eyes look more awake and alert. Depending on whether it’s performed on the upper or lower lids, it can reduce droopiness, get rid of under eye bags, and generally rejuvenate the eye area.
But there are cases when eyelid surgery is medically necessary and, in those cases, an insurance policy might provide some coverage.
Some people suffer from a condition known as ptosis, which causes the upper eyelid or eyelids to droop over the eye. In some cases, the drooping isn’t particularly noticeable and doesn’t interfere much (or at all) with a person’s day-to-day life.
In other cases, the drooping can be bad enough that the skin of the eyelid actually makes it difficult for a person to see. If your vision is impaired by a drooping eyelid and surgery is the best option for repairing the problem, your healthcare plan will likely offer at least some coverage.
Talk to Your Insurance Company Before You Schedule Surgery
It’s a good idea to get in touch with your insurance company before you schedule a procedure to see if there is a chance they offer any sort of coverage. Some policies require you to get pre-authorization or pre-approval before your surgery. The pre-authorization gives the company a chance to confirm that the plastic surgery is medically necessary and that there isn’t a better, less expensive treatment option out there.
Even if your policy doesn’t require pre-approval, it’s still a good idea to call up before the day of your procedure or even before your consultation to get an idea of what your policy will and won’t cover. Some plans will offer payment in full, others might expect you to pay 50 percent or another portion of the cost.
Knowing what your financial responsibility might be can help you decide how you’ll cover the remaining costs of the treatment, if any.
If you need any sort of reconstructive plastic surgery, it pays to see one of the top-rated plastic surgeons in the country. In Houston, Texas, Dr. Paul Vitenas is a board certified surgeon who has been named a top doctor several times. To schedule a consultation with Dr. Vitenas and learn more about your surgery of choice, as well as payment and insurance options, call 281-484-0088 today.
