Will Insurance Cover My Procedure?
Published on May 17, 2023
By Plastic & Reconstructive Surgery of Acadiana
Plastic surgery is a personal choice that encompasses many factors. While most people choose plastic surgery to improve their appearance, not all plastic surgery is elective. Some plastic surgery procedures go beyond aesthetics and have health, psychological, and lifestyle benefits.
One of the deciding factors for surgery is cost. The question we receive most often is if insurance covers the cost of plastic surgery. While in most cases the answer is no, in some instances, insurance will pay for reconstructive surgery. Insurance plans vary widely, and you should always contact your provider to check eligibility.
Getting Plastic/Cosmetic Surgery
There are many reasons to get plastic surgery. For many, it could be to enhance certain parts of their appearance. Some plastic surgery procedures go beyond aesthetics and have health, psychological, and lifestyle benefits.
Are you considering treatment to correct a medical, physical, or emotional issue? Do you have severe skin laxity that is causing you emotional distress? You can find out if insurance can cover some of the surgical costs.
Reconstructive vs. Cosmetic Surgery
The terms reconstructive and cosmetic are often used interchangeably when describing plastic surgery. However, they can be very different in what they cover. Reconstructive surgery usually describes a procedure that corrects something that significantly impacts the patient’s life. Breast reconstruction after a mastectomy due to cancer differs from getting breast implants for purely cosmetic reasons. Rhinoplasty to correct a deviated septum is not considered cosmetic. It is different from surgery to change the appearance of the nose.
Conversely, cosmetic surgery is usually not medically necessary, but instead is something that the patient desires to improve the appearance of a body part. Some examples of this are breast lifts to correct sagging, or liposuction to remove fat.
Insurance and Surgical Correction
To determine if insurance will cover the procedure, consider the purpose of the surgery. As a rule, insurance will not pay for a procedure that is purely about improving the patient’s appearance. However, if a defect affects the function of a body part, insurance may cover the cost of surgery. For example, if severely hooded eyelids obstruct an individual’s vision, insurance may cover all or part of an upper blepharoplasty. Surgical correction to repair trauma or injury is almost always covered. Repairs necessary after cancer typically fall under the coverage of insurance also.
Purpose of the Procedure
The decision to cover the procedure lies with the insurance company. If the goal of surgery is to improve or correct a medical issue, you may receive full or partial coverage from insurance. However, individual circumstances and insurance plans vary widely. Testing and documentation by the healthcare provider is used to determine coverage. This process can be tedious and generally takes 4 to 6 weeks for paperwork to process. Speak with your insurance provider and the surgeon before the procedure to determine whether the treatment qualifies for coverage.
Procedures Covered by Insurance
Several cosmetic or reconstructive procedures are often partially covered by insurance. They include:
Abdominal reconstruction (Panniculectomy and/or Hernia repair)
Eyelid surgery (Blepharoplasty)
Very few plans cover surgery costs at 100 percent and many plans have automatic exclusions. If a procedure is allowed by the insurance plan, the doctor must have prior authorization before planning the surgery. You will need to cover costs out of pocket if you have a deductible or a cost sharing plan. When you visit our clinic, we will take care of the paperwork and requests for coverage. If there is a denial or gap in coverage, we can facilitate payment plans through CareCredit. With it, you will benefit from 0% interest for 12 months.
To learn more, call Plastic & Reconstructive Surgery of Acadiana at our Lafayette, Louisiana office (337) 504-3640.