Why Cosmetic Surgery is Not Covered by Insurance

Find out why cosmetic surgery is usually not covered by health insurance and what types of plastic surgery may be eligible for coverage.

Why Cosmetic Surgery is Not Covered by Insurance

Health insurance companies usually do not cover cosmetic procedures, as they are not considered medically necessary. That means the expense will fall on your shoulders. All of that is great if you undergo a procedure that will make you feel good about yourself. The answer to this question is not necessarily black and white. Whether or not a procedure is covered by insurance depends largely on several factors.

Often, the deciding factor is whether the insurance company considers the procedure medically necessary. Purely cosmetic procedures are therefore not covered. For example, a patient who wants a facelift to treat cosmetic signs of aging would not be eligible for insurance to cover the procedure. Policies must cover at least 10 essential health benefits, but unfortunately, cosmetic surgery is not among them. Despite the fact that the amount of plastic surgery has increased significantly since 1997, according to the American Society for Aesthetic Plastic Surgery, most cosmetic surgeries are still not covered by insurance plans. Cosmetic surgery is usually not covered by health insurance because it is elective.

It is your choice and is not considered a medical necessity. No, elective cosmetic surgery should not be covered by health insurance as it would place an unnecessary burden on the cost of health care.

Although insurance coverage for a paniculectomy or tummy tuck is not as common as weight-loss surgery, they may be considered medically necessary if a patient is in pain, unable to participate in normal activities, or is at risk of developing a skin condition.

This makes it difficult for people who want to have surgery because of conditions that are in the gray area between cosmetic and medically necessary, difficult for the doctors who care for them, and a challenge for insurers whose goal is to minimize their expenses. Health insurance tends to cover certain types of plastic surgery, such as breast reconstruction after a mastectomy or repair of a cleft palate. It's a cosmetic procedure, and health insurance shouldn't pay for a procedure that's done to make someone look better. Still, like work-based plans, marketplace plans usually cover surgery that aims to repair a birth defect. The question of whether plastic surgery is covered by insurance depends on the details of your insurance policy.

Here are a few different procedures by category where plastic surgery may be covered by insurance:

  • Facial reconstruction after an accident or injury
  • Breast reconstruction after mastectomy
  • Repair of cleft palate
Some plastic surgeons accept major credit cards or offer financing programs that allow patients to make manageable monthly payments for cosmetic surgery. In this scenario, an insurance company may partially cover a blepharoplasty (or eyelid lift) if it can be proven that it is medically necessary. Facial cosmetic surgery has been associated with modest improvements in quality of life, self-esteem and body image. Consulting with a board-certified plastic surgeon will give you clarity on whether your preferred surgical procedure could qualify for insurance coverage under your health plan. Your insurance company's service coverage and payment levels depend on the terms of the contract between you and your insurance company. Cosmetic plastic surgery is generally not covered by insurance, but reconstructive or medically necessary plastic surgery is more likely to be covered. Explaining in detail the procedure you plan to perform and requesting confirmation that you are covered, planned services are covered, and the level of coverage of planned services can help you determine if your desired plastic surgery will be covered by your health plan.

Bryant Devitt
Bryant Devitt

Hardcore coffeeaholic. Wannabe music trailblazer. Typical tv maven. Incurable food scholar. Proud coffee trailblazer.

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