Cost is an important factor in the decision to undergo plastic surgery. One common question Dr. Rob Kessler receives when patients are thinking about plastic surgery costs is whether their procedure is covered by medical insurance. Dr. Kessler, a plastic surgery specialist in Newport Beach, addresses the ins and outs of plastic surgery insurance coverage in this post.
Most Elective Surgeries Not Eligible for Insurance Coverage
The majority of plastic surgery procedures are performed for cosmetic reasons — i.e., to improve the aesthetic appearance of the face, body or breasts. Since cosmetic procedures are optional, most insurance companies do not offer coverage.
However, not all plastic surgery procedures are performed strictly to improve appearance. In some cases, patients have legitimate medical problems that can be fixed with a plastic surgery procedure. And under those circumstances, insurance companies may cover part or all of the related costs.
Here are some examples:
- Breast reduction: Many breast reduction candidates suffer from serious medical problems — such as chronic neck, back or shoulder pain, posture problems or breathing problems — due to oversized, heavy breasts. Insurance companies may cover breast reduction if the candidate has a well-documented history of these kinds of problems, and the surgery meets special criteria. For example, insurance companies can require that a certain amount of tissue be removed from each breast during surgery for the patient to qualify for reimbursement.
- Breast reconstruction: Breast reconstruction recreates one or both breasts after cancer. Most procedures are covered by insurance; in fact, the Women’s Health and Cancer Rights Act of 1998 require all group health plans that pay for mastectomy to pay for prostheses and reconstructive procedures. This applies to reconstruction procedures that are performed at the time of mastectomy (or lumpectomy) or afterward.
- Upper blepharoplasty (eyelid surgery): Some blepharoplasty procedures are eligible for insurance coverage if the eyelid skin droops into the line of sight, obstructing vision. If a doctor can document that the surgery will remove the obstruction, insurance may cover the procedure. Note that insurance companies don’t cover blepharoplasty of the lower eyelid.
If you are hoping that insurance will cover your procedure, it is best to communicate with your provider up front as you are planning surgery to determine exactly what is covered, as opposed to trying to track down payment after surgery. Our office staff can help answer general questions, but the best resource for information about your plan is your provider.
Contact Our Plastic Surgery Office
If you have a question about plastic surgery costs, or if you would like to schedule a personal consultation with Dr. Kessler, please call or email our office today.