Does Medical Insurance Cover Cosmetic Surgery?
Based on the health insurance plan’s terms, your plastic surgery needs may be catered for by your health insurance policy. This happens when the surgery you are set to undergo is non-cosmetic and reconstructive.
In 2018, more than $16.5 billion was spent by Americans on cosmetic surgery, according to a report by the American Society of Plastic Surgeons. The question is, Under which conditions does your insurance policy cover for your plastic surgery?
The category of health insurance and your insurance company determines who will pay for the costs of plastic surgery. The procedure to be undergone is also a determinant factor. To find out if coverage will be available for your procedure, it is of importance to see if the surgery is reconstructive, cosmetic, or vital for normal body functioning or enhancing your life quality.
Insurance policies vary regarding what to be considered a covered procedure. However, guidelines exist that most of the insurance companies follow when it comes to defining what is to be considered reconstructive or necessary and cosmetic.
Defining the Terms in Plastic Surgery Health Insurance
Most of the insurance companies still follow the definitions given by the American Medical Association and the American Society of Plastic Surgeons to differentiate between a surgery that may be considered reconstructive, cosmetic, or medically necessary.
- Reconstructive surgery: This is the type of surgery that is performed on abnormal body structures that are caused by tumors, trauma, infection, congenital disabilities, and disease. It may also include surgery performed to create an improvement in functioning or provide a healthy appearance.
- Cosmetic surgery: this type of plastic surgery constitutes surgical and also nonsurgical procedures that enhance and redefine the shape of body structures to boost confidence and appearance.
Cosmetic vs. Medical Plastic surgery
What insurance policies consider cosmetics and what they deem medically necessary is dependent on the insurance company and may experience changes over time. The basis of the changes is:
- Your insurance type
- Patient needs
- Introduction of new medical treatments and procedures.
Costs of Plastic Surgery and Procedures that Insurance can cover
Using the information provided by ASPS, a list was compiled showing what your insurance cover should put consideration into:
- Abdominal Surgery: It should be considered if it is performed to either improve or eliminate sores, rashes, back pain, or hernia or help in improving your ability to maintain the right walking posture.
- Breast surgery: It should be considered if it is performed to make body parts symmetrical, make large breasts smaller (if they are causing problems to your health), carry out reconstruction of lost body parts, or reduce large breasts in males and in cases of congenital absence.
- Ear surgery: Insurance companies should consider eye surgery if it is done to correct ears that were deformed by injuries, diseases, or even birth.
- Eyelid surgery: This should be considered if it is carried out to correct eyelids that have abnormally turned in or are drooping and making it difficult to see.
- Facial surgery: Your insurance company should consider this if it is done to provide a balance in appearance in cases of paralysis or correct deformities that may exist in the head, neck, or facial muscles.
- Hand surgery: Hand surgery should be considered if it is done to treat nerve injuries, fused fingers, Dupuytren’s contracture, or different other deformities.
- Nasal surgery: Insurance companies should consider it if the procedure is carried out to correct those deformities that arise from diseases, breathing problems, or birth.
Cosmetic Surgery that your Insurance is unlikely to cover
Since 1997, there has been an increase in the number of procedures (cosmetic) done. (Over 538% for women and 325% for men) in accordance with the statistical data gathered by ASPS in 2015. It now makes sense why people are seeking to get competition from their insurance companies for the procedure that may be covered by their health benefits plans.
Sadly, most insurance plans do not cover elective surgery because it is optional, and nobody considers it medically necessary. Liposuction, eyelid augmentation, and surgery are unlikely to be covered by your health insurance, although there are exceptions.
Non-cosmetic Surgery your Insurance is likely to cover
Plastic surgery is not purely cosmetic if you need it for your body to continue functioning healthily. If you possess a comprehensive plan, procedures following road accidents or situations in which your body has to undergo repair to function normally are likely to be covered by your insurance provider.
Health insurance providers have varying coverages and may either restrict or exclude procedures. You have to find out whether or not your company offers non-cosmetic plastic surgery. You have to always check this before deciding on any procedure to avoid incurring unexpected costs.
More in Health Insurance
It’s Never Too Late To Dream – Finding Purpose After 50
Do you ever feel like a robot going through life in a monotonous state of mind? You are not alone. Many...October 28, 2019
Is It Depression Or Sadness? Here Are The Most Common Mental Health Disorders and Symptoms
The number of individuals who are suffering from mental health disorders is multiplying by the day. It could be said that...October 24, 2019
Super Fun Activities You Never Thought Burnt Calories
Exercising isn’t everybody’s cup of tea. For some of us, a visit to the gym can result in aching muscles and...October 22, 2019
Headache? Constipation? Nausea? Your Kitchen Is Packed With Natural Remedies!
Before modern medicine, people from all over the world used natural herbs and plants to cure general illnesses. Home remedies have...October 21, 2019
The Non-Diet Approach to Weight Loss
Dieting has become a way of life. We have started to replace the standard ‘How are you?’ with ‘How is your...October 18, 2019
How To Support Someone With Mental Health Issues
A vast majority of society has struggled at one point with mental health issues. If you have ever been faced with...October 17, 2019
Optimists Do It Better – Practice Positive Thinking and Improve Your Life
We all know someone who looks like they are always happy and that nothing can ever bring them down. That person...October 16, 2019
Calisthenics – Building Strength and Flexibility In The Comfort Of Your Home
Finding new and exciting ways to exercise can be a bit of a headache. First of all, you need to find...October 14, 2019
Discover This Excellent Tool To Overcome Anxiety
The mind is a mighty device and can be used to alter reality and determine your life experience. To achieve a...October 9, 2019