If you’re interested in a particular plastic surgery procedure, one of the first things you’ll likely look into is how to cover the cost, and specifically whether the procedure will be covered by your standard medical health insurance. Here are some basics on this issue to take into consideration.
Generally speaking, your medical insurance will only cover procedures that the insurer considers a medical necessity. Insurance companies make a distinction between “reconstructive surgery”, which aims to remedy an issue that is tangibly affecting a patient’s quality of life, and “cosmetic surgery” which has to do purely with improving the patient’s self-esteem or appearance.
Certain procedures have a precedent of being covered:
- Breast reconstruction after a breast cancer surgery would likely be covered, as would a breast reduction procedure if there is adequate proof that the current breast size is negatively affecting the patient’s quality of life. In addition, reconstructive plastic surgery after any kind of accident would also likely be covered.
- A septoplasty would likely be covered if the deviated septum is preventing the patient from breathing normally, but standard rhinoplasty would not be covered.
- Many insurance companies will pay for gastric bypass surgery and liposuction for those who are morbidly obese, after the patient has tried other methods of losing weight and failed. However, the insurance will not cover removing the excess loose skin resulting from the significant weight loss due to a gastric bypass procedure or liposuction.
You may notice that a lot of the metrics that decide if a surgery is a medical necessity or a cosmetic one are not hard and fast—there’s definitely a gray area when it comes to what procedures could tangibly improve a patient’s quality of life. That’s why it’s important to find a plastic surgeon who is willing to work with you and with your insurance company to make a case for why the procedure is medically necessary. Keep in mind that if your insurer denies you coverage for a procedure you indeed consider medically necessary to improve your quality of life, you can also appeal the decision and try to get them to change their verdict.
In order to ensure you don’t get stuck having to pay for a procedure that was supposedly covered by your insurance but if fact is not covered, try to get confirmation from your insurer in writing, or have your plastic surgeon check with the insurance about precisely which parts of the procedure are covered, so you can stick to these covered portions and eliminate any extra services.
Finally, it’s important to remember that medical insurance isn’t the only option for paying for a plastic surgery procedure. Many plastic surgeons are able to offer financing that makes it easier to pay for a procedure over time instead of all at once.
Do you have a question about whether a procedure is covered, or about financing options for a procedure? Contact St. Charles Plastic Surgery today to set up a consultation with Dr. Ghaderi.
