More than six million Americans opt for cosmetic surgery every year. Most of them are curious whether there are insurance policies that can cover the costs, totally or at least partially. This is possible, usually, if there is a medical endorsement for the same. Whenever there is a need for reconstructive surgery (or a surgery that is medically certified as essential) rather than purely cosmetic surgery, then insurance options are easy to find.
- Each insurance provider may have almost two dozen plans for different types of cosmetic surgery. Examples of reconstructive and medically essential cosmetic surgery covered by insurance are
- Correcting the deviated septum of the nose to lessen symptoms of the sinusitis
- Repairing birth defects like cleft palate
- Correction by cosmetic surgery after an accident
Examples of cosmetic surgery that are not considered medically essential are
Liposuction (when excess fatty tissues below the skin are removed by means of suction)
It is important to research well the options available for the particular surgery you seek. Almost all insurance companies offer policies based on the definition of reconstructive surgery by the American Medical Association and the American Society of Plastic Surgeons. Accordingly, the following are qualified to receive insurance coverage
Abnormal structures caused by
- Congenital defects
- Developmental abnormalities
- Disease
- Infection
- Tumors
- Trauma
Surgery to improve function
Surgery to facilitate a normal appearance of face or body by correcting deformity caused as birth defect, stress, trauma or accident
Cosmetic surgery, defined as reshaping normal structures on the body to improve self esteem or appearance, is not usually covered by insurance.
How the AMA and ASPS guidelines are interpreted depends on the insurance company. Here are the instances that receive coverage
If the surgery you want done is reconstructive and eligible for insurance coverage you can discuss the same with your doctor. The doctor will endorse the need for the surgery and also help you contact a good insurance provider.
There are some surgeries, however, that fall into both reconstructive and cosmetic categories. They are
Rhinoplasty or Septoplasty creates a better look for nose and thus the whole face, while it may be considered important to improve the breathing problem of the patient
Surgery for droopy eyelids will improve appearance though it can be considered essential for improving vision
The insurance company may require additional endorsement and medical certificates from a qualified health care giver to prove that surgeries mentioned above are essentially reconstructive and being done to relieve disorders and not for cosmetic improvement.
Please note that the insurance coverage will be an undertaking between you and the policy provider while the surgery itself and related services will be an agreement between you and the surgeon. The three types of insurance coverage generally available are
- The flat rate co-payment type
- The deductible type
- The percentage based co-payment type
The insurance company will explain to you these types to help you choose wisely the coverage that suits you best. However, you should always remember that insurance options are available only if cosmetic surgery addresses a genuine medical concern rather than improvement of overall appearance.
Does insurance cover cosmetic surgery costs is a query that has both “Yes” and “No” for answers! If the surgery is reconstructive, it creates a legitimate premise for seeking insurance. Cosmetic surgery that is exclusively performed to improve appearance is usually not covered by insurance.