Insurance Coverage for Plastic Surgery

If you are considering a plastic surgery procedure, you've probably heard that your insurance company won't pay for the costs. This is because the majority of plastic surgeries are considered elective – meaning that you have a choice whether to receive them or not.

Yet, for some individuals, plastic surgery is medically necessary – and required for their overall health and wellbeing. When this is the case, your insurance company may pay a portion or even ALL of the procedure costs.

For this to happen, however, a doctor must establish a legitimate medical issue necessitating the plastic surgery. But what are some of the procedures that could actually qualify for insurance coverage? You might be surprised to learn that there are more of them than you think!

Nose Jobs

Surgical changes to the nose purely for aesthetic reasons, otherwise known as rhinoplasty, will not be covered by insurance.

Insurance may, however, cover septoplasty for some patients, especially those who suffer from breathing problems caused by a deviated septum, but only if the issue has been documented by a doctor. Proper documentation is a necessity – as is proving that the surgery is medically necessary.

Eyelid Surgery

Insurance may cover surgery for droopy skin around your eyes if it is interfering with your sight- if tests can verify that the procedure will improve your vision. Insurance companies, however, will never pay for surgery to the lower lids, referred to as blepharoplasty.

Invisalign

If your dental insurance policy has orthodontic benefits coverage, it will offer this without restrictions to the type of braces you wear.

Typically, insurance companies will reimburse customers up to 50% of the cost of their orthodontic work. This could still leave the customer with substantial out-of-pocket expenses considering the average orthodontic bill runs approximately $5,000.

Breast Reduction

This procedure is paid for by many insurance companies. In order to do so, however, they often require that a patient’s primary physician establishes back, neck or shoulder pain caused by macromastia (large breasts). Additionally, it may be necessary to try addressing the problem with physical therapy first.

To be seriously considered, the amount to be removed must be significant. Removal of a minimum of one pound of tissue from each breast is usually necessary to qualify for insurance coverage for reduction mammoplasty.

Medicare Coverage

Patients can expect assistance from Medicare for breast prostheses for breast reconstruction after mastectomy because of breast cancer treatment. Medicare also pays for cosmetic surgery to repair damage caused by accidental injury or to enhance the function of a malformed body part.

Weight-reduction Surgery

Following a customary psychological evaluation and year-long period of supervised diet and exercise, insurance companies will often pay for morbidly obese patients to undergo gastric bypass surgery.

Follow-up surgeries, such as liposuction, tummy tucks, and excess skin removal will all be considered cosmetic, however, and will not typically be covered.

Know Your Options

While a determination of medical necessity is required for insurance coverage of these procedures, there is legal recourse for patients who have been initially denied benefits. The protocol for the appeals process should be outlined in the denial letter you received from your insurance company.

Contact Pasadena Plastic Surgery Specialists

If you are considering plastic surgery, it is important to choose a plastic surgeon carefully. Pasadena men and women continue to choose Dr. Kevin Ruhge to perform their surgeries. His personalized approach to plastic surgery means that his clients can contact him 24/7 after a surgical procedure.

If you would like to learn more about face-lifts, breast augmentation, rhinoplasty, or any plastic surgery procedure, we invite you to meet with Dr. Ruhge for a private consultation at our office in Pasadena by calling 626.397.9095, or by scheduling an appointment online.