The New You Awaits
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The New You Awaits
Many patients ask Dr. Rosso what plastic surgeries their health insurance covers. His answer is not as simple as he would like it to be: “Generally, medical insurance covers plastic surgery that is reconstructive and non-cosmetic but each policy defines these two elements somewhat differently.”
What you need to know about health insurance coverage
Most health insurance policies, do not cover “Cosmetic” procedures. These are surgeries that reshape normal structures in the body to improve self-esteem or appearance.
On the other hand, insurance policies tend to cover surgeries performed on abnormal structures caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease.
However, what Insurance companies consider Cosmetic Surgery is up to them and changes based on the type of insurance you have, your particular needs, the availability of alternative procedures and medical treatments.
These common procedures are not covered, unless…
- Breast augmentation
- Eyelid surgery
These surgeries are considered “optional” and insurance companies will not cover them although exceptions due to extraordinary circumstances may apply. This is better determined once an experienced Plastic Surgeon like Dr. Rosso visits the patient and communicates his diagnosis to his or her insurance.
It’s important to know that each insurance company has its own guidelines, Terms and Conditions. If you get the surgery before getting it approved by your insurance, they will not pay for it afterward.
What surgeries might be covered
Insurance companies place a lot of emphasis on the reasoning behind a procedure. Coverage is possible if your situation is NOT OPTIONAL such as an issue caused by cancer (including skin cancer) or other illnesses, a car accident, a burn incident, scar revision and so on. In these situations, the probabilities that you can get coverage are high.
The American Society of Plastic Surgeons has compiled a list of surgeries that are likely to get covered:
- Abdominal Surgery: If performed to correct health issues i.e. back pain, hernia, rashes, or improve the ability to walk well.
- Breast Surgery: If performed to improve asymmetry, reduce large breasts causing health problems, reconstruction due to loss, congenital absence (was born with only one breast), or reduce large male breasts.
- Ear Surgery: If performed to correct deformed ears by birth, disease, or injury.
- Eyelid Surgery: If performed to correct drooping eyelids that are causing vision problems or correct abnormal eyelids.
- Facial Surgery: If performed to balance the appearance if caused by paralysis, deformities in the facial muscles, head, or neck.
- Nasal Surgery: If performed to correct deformities resulting from birth, disease, trauma or breathing problems.
Dr. Rosso’s experience is exceptional—if you can get coverage, he will know how. On our website, you will find a list of Insurance companies we accept as well as the possibility to apply for alternative financing options (CareCredit).
If you have questions regarding insurance coverage, please give us a call at 310-326-3636