To be covered by health insurance, a medical procedure needs to be considered essential to your health. The truth about most cosmetic surgeries is they are not necessary, meaning many will not be paid for by your plan.
Plastic surgery is a procedure that looks to fix physical deformities or handicaps, which can be caused by illness, injury, and in some cases, congenital disabilities. Cosmetic surgery is used to enhance or improve physical traits, meaning that insurance may not cover such procedures not considered vital to your health.
That being said, your insurance policy may cover some cosmetic surgeries depending on specific terms and conditions, and if the procedure is considered reconstructive.
Let’s take a look at some of the factors that can and will determine if your insurance will cover a certain procedure.
How to Determine if Health Insurance Covers Plastic Surgery
Almost all insurance companies abide by the definitions provided by the American Medical Association and the American Society of Plastic Surgeons. These definitions state that:
- Reconstructive surgery is a procedure done to enhance or fix abnormal structures or deformities, trauma, infection, tumors, or illness. In some cases, this can be a cosmetic surgery done to improve a person’s physical appearance.
- Cosmetic surgery is a plastic surgery that looks to improve a person’s physical appearance. It is a surgical procedure done to reshape and alter the look of a specified body part. It also can indirectly help to improve your self-esteem.
Reconstructive vs. Non-Reconstructive Surgery
Reconstructive plastic surgery is understood to be necessary from a medical standpoint and should be covered under most health plans. Some reconstructive procedures that are also considered cosmetic because they relieve pain and discomfort are breast reductions, nose jobs (to treat deviated septums), and some weight-loss treatments.
Non-reconstructive cosmetic surgery usually is not covered under most health insurance plans. Most companies view cosmetic plastic surgery as a vanity procedure unnecessary for the well-being of the patient, explaining why the expense is not covered.
To determine if the procedure will be covered, it is essential to find out if:
- It is cosmetic plastic surgery.
- It is reconstructive surgery.
- It is trivial or essential to preserving your quality of life.
Policies can differ regarding what they cover and what they don’t, and what they consider necessary or vanity. Most of the companies follow the definitions mentioned above as a guideline to determine what is deemed to be reconstructive surgery. Each health insurance policy differs in terms of what they consider a medical procedure that is vital to your health, therefore take a good look at your policy’s wording to find out what you are covered for.
Plastic Surgeries and Procedures That May be Covered
According to the ASPS, we compiled a list of procedures that may be covered by your insurance:
- Abdominal Surgery: When done to reduce health concerns.
- Breast Surgery: For breast reductions that can alleviate back problems, correct asymmetry, or help address some birth defects.
- Eyelids: If performed to improve vision or remove something impeding vision.
- Facial Surgery: When done to improve or fix deformities, or to correct the consequences of an illness, such as facial paralysis.
- Nose Surgery: When used to fix breathing issues such as a deviated septum.
If you feel you qualify for one of these surgeries, we recommend you make an appointment with a board-certified plastic surgeon to discuss your options.
Cosmetic Procedures Not Covered by Health Insurance
In recent decades, cosmetic surgery’s popularity has been on a steady incline. According to the American Society of Plastic Surgeons, the industry’s business is now valued at more than $10 billion annually.
The number of people undergoing cosmetic plastic surgery has risen consistently on a year-over-year basis, with growth at an extremely high rate of five percent in some cases. Of these people, women comprise 90 percent of the patients, although we do have to point out that increasing numbers of men are undergoing cosmetic surgeries too.
Unfortunately, most cosmetic procedures are not covered by insurance because they are viewed as elective, not medically necessary.
Some surgeries that are typically not covered by health insurance include:
- Liposuction
- Breast Augmentation
- Fat Transfer (Fat Grafting)