Does Health Insurance Pay for Plastic Surgery?
Your health insurance policy may pay for plastic surgery depending on the terms and conditions of your health insurance plan if surgery is considered reconstructive and non-cosmetic. According to the American Society of Plastic Surgeons, 13.5 billion dollars was spent on plastic surgery in the US in 2015. That makes a lot of money for doctors’ fees, so who has to pay for plastic surgery?
The answer to this question depends on several factors.
When does health insurance cover plastic surgery coverage?
Who pays the cost of plastic surgery depends entirely on your insurance company and how the procedures you need to get are defined. It is important to know whether the surgery is cosmetic, or reconstructive, or important for bodily functions or maintaining your quality of life as part of the process to determine whether it will be discussed. Although insurance policies can vary in terms of what is considered a procedure covered, there are several guidelines that must be considered by insurance companies when referring to definitions of what is considered reconstructive or necessary and what is considered cosmetic.
What is the Definition of Plastic Surgery Included or Not Covered in Health Insurance? Most insurance companies follow the definition given by AMA (American Medical Association) and the American Society of Plastic Surgeons (ASPS) which states: Reconstructive demolition operations refer to operations performed on abnormal structures caused by congenital defects, developmental abnormalities, trauma, infections , tumor, or disease. This can include surgery to improve function or give a normal appearance.
- Cosmetic surgery is the re-establishment of normal structures in the body to improve the self-esteem or appearance of the patient.
Health Insurance Companies Can Evaluate What Is Covered For Different Plastic Surgery
Insurance companies are interpreters of the definition above. Take for example the procedure of circumcision in a baby boy. In the past insurance companies paid for this procedure, but it is now increasingly common that insurance companies will not pay for the procedure because it is considered cosmetic. What is considered cosmetic plastic surgery depends entirely on the insurance company that holds your policy and can change over time based on the type of insurance you have, research needs and patients, and the evolution of new medical procedures and treatments.
Examples of Cosmetic Surgery may not be covered by health insurance
The number of cosmetic procedures performed among women has increased by more than 538% and 325% for men since 1997, according to the 2015 ASPS statistics. It makes sense that people are looking to receive compensation from their health insurance for each procedure that their health care plan can cover. Unfortunately, cosmetic surgery is not one of the things covered by most health insurance plans because of the fact that it is a choice and is usually not considered necessary to maintain quality of life or bodily functions.
The following are examples of non-routine operations covered by health insurance, although exceptions due to extraordinary circumstances may apply. .
- Breast Augmentation
- Eyelid Surgery
Examples of Health Insurers Using Psychiatric Evaluations to Associate Plastic Surgery Procedures Including Weight Loss Surgery
Although liposuction and abdominal folds are usually considered cosmetic, there are extraordinary circumstances where a person who is considered obese is unhealthy and has a psychiatric evaluation that shows that being overweight influences the quality of life they lead, health insurance companies may allow consideration of medical procedures to be covered by health insurance benefits. However, this is usually only done after a long-term evaluation, and extensive evaluation, combined with a program monitored by doctors for the first time trying and overcoming this problem with a non-surgical weight loss program and other methods.
Operating weight is usually not closed and requires a truly extraordinary situation.
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Examples of Non-Cosmetic Plastic Surgery That May Be Included in Health Insurance
For example, if a plastic surgery procedure is needed to preserve healthy bodily functions, it is not necessary. As cosmetics. Procedures following car accidents, major accidents, or situations where your body needs to be repaired so you can resume the quality of life functions and the body may be closed by your health insurance company if you have a comprehensive plan.
If the doctor identifies the procedure needed to live properly, this might not be considered cosmetic. However, insurance companies may require a non-surgical solution to be exhausted before the procedure is approved.
Remember that every health insurance company has its own protection and may limit procedures, or exclude them. . You must first find out if your health insurance company covers non-cosmetic plastic surgery. This must always be verified before any procedure so that you do not incur unexpected costs.
Examples of nose jobs that might be covered by health insurance
Julie has a lot of breathing problems normally, she can’t sleep well and health is generally affected. He knew that he had a distorted septum that caused problems. If the doctor shows that this is a necessary surgery and not cosmetic, then the work he gets on his nose after a deviated correction of his septum may be under closed plastic surgery.
Examples of breast surgery that may be covered by a health insurance plan
Susan has very large breasts that cause extreme discomfort and makes it difficult for her to participate in various physical activities. He experienced severe shoulder and back pain and his quality of life was significantly affected by the situation. After the doctor performs a complete examination to find out the source of the problem, the doctor explains that the problem is caused by the weight of her breasts, and recommends breast reduction surgery. Susan discussed this problem with her health insurance company and was obliged to submit various forms and additional information from her doctor. They initially refused coverage which showed that physical therapy or chiropractic care or pain medicine could solve this problem. Susan followed these instructions for almost a year,
Susan then completed a series of new forms and information from her doctor again. After reviewing the information, his health insurance company agreed that this was not a cosmetic procedure and advised Susan that the procedure would be included in the benefits.
Examples of Variations Between How Insurers Health Insurance Evaluate Plastic Surgery: Be careful!
A few months later, Susans’ friend had the same diagnosis, he applied for the same procedure and was refused, he discovered that his insurance company did not consider the procedure as important as that, and so he ended up paying all of the bags, which cost $ 10,000. He was glad he had known beforehand from his health insurance company that he was not eligible to get coverage of health benefits in the operation.
How to Ensure Your Plastic Surgery Is Included in Health Insurance Before You Schedule a Procedure
- Contact the manager of your health insurance plan or insurance company directly and find out what coverage you have for plastic surgery. Procedure
- Get accurate estimates with detailed cost estimates for your plastic surgery procedures so you can check them based on the scope of your policy
- Find out what you can deduct when there is coverage
- Find out what is the maximum amount to pay, and if they expect you to pay a certain percentage of the procedure
- Find out related drugs such as pain killers that will be discussed
- Consider whether the insurance company can pay for part of your procedure with a half entry as a health benefit and you can pay half the cosmetics. Your doctor and specialist may be able to help you here.
- Note the details of writing your cover so you are not surprised. Never assume anything is closed unless your health insurance company confirms it.
This situation makes the scope included in the health plan difficult to define. Always check with your health care provider before you make any assumptions. The line of what is closed or not shaded in many cases and it is difficult to determine what is considered necessary or only cosmetics. In some cases, only part of the operation can be covered, which makes it more complicated. Be prepared before you try and submit your health insurance claim. Here are more details and examples about
Examples of Costs of Plastic Surgery and General Procedures that may be covered by insurance
The following is a list compiled with information from ASPS regarding surgery that your insurance company might consider:
- Abdominal Surgery: If done to repair or eliminate health problems such as back pain, wounds, hernias, rashes, or help improve normal walking ability.
- Breast Surgery: If done to improve asymmetry, reduce large breasts that cause health problems, reconstruction due to loss, congenital absence (born with only one breast), or reduce large male breasts.
- Ear Surgery: If done to repair defective ears with birth, disease, or injury.
- Eyelid Surgery: If done to repair drooping eyelids that cause correct vision or eyelid problems that change in abnormal ways.
- Facial Surgery: If done to balance appearance if caused by paralysis, treat abnormalities in the face, head or neck muscles.
- Hand Surgery: If done to treat carpal tunnel syndrome, Dupuytrens contracture, nerve injury, tendon injury, fused fingers, or other abnormalities.
- Nasal surgery: If done to correct a deformity due to birth, illness, or problem with breathing.
If you feel burdened in this category, it’s important to talk to your doctor. Your doctor can ascertain whether your condition will be considered reconstructive and can help you contact your insurance company.