Does Health Insurance Cover Plastic Surgery Costs?
Health insurance may pay for plastic surgery, but generally only if the procedure is medically necessary.
Most health insurance doesn’t cover plastic surgery, but there are times when it is medically necessary. For example, reconstructive surgery to fix birth defects or cosmetic changes caused by illness or accident may be covered. Most of the time, health insurance won’t pay for treatments that only change the way something looks.
Does health insurance cover surgery to make you look better?
Procedures that aren’t medically vital aren’t covered by health insurance. Most insurance companies don’t think elective cosmetic surgery is medically important, so it’s not covered by standard health insurance. Procedures that are done just for looks are not necessary for your health.
Even when insurance pays for plastic surgery that is medically necessary, some plans may not pay for it in full. Insurance companies might only pay for part of a treatment or testing done before surgery. You’ll still be responsible for any co-insurance, copays, or premiums.
When could a health insurance plan pay for plastic surgery?
Reconstructive surgery or other types of plastic surgery that are medically important might be covered by health insurance. Your HMO, PPO, or other type of health insurance may cover treatments that will improve your health as a whole, such as weight loss surgery for people whose extra weight makes their health problems worse.
Sometimes it’s not clear if a treatment is for looks or to fix something. Some of these treatments follow rules set by the American Society of Plastic Surgeons (ASPS). If you’re thinking about getting plastic surgery, these tips can help you decide if your process falls into the category of “reconstructive.”
For example, a rhinoplasty done for looks is not restorative. But a nose job is medically important to fix deformities that make it hard to breathe.
What is cosmetic surgery, and does insurance cover it?
Reconstructive surgery fixes cosmetic problems caused by illness, accident, or when a person was still in the womb. Most of the time, cosmetic procedures to fix these deformities or abnormalities are physically necessary.
Some examples of reconstructive surgery that your health insurance might cover are breast augmentation to make the breasts look the same size (even if it’s not because of cancer treatment), fixing a cleft lip, fixing a deviated septum, and removing skin lesions.
People who choose to get cosmetic surgery just to change how they look aren’t doing something that is medically important. Face lifts, breast enlargements, and liposuction are all examples of these kinds of operations.
How to find out if your health insurance will pay for plastic surgery
If you know if your insurance offers cosmetic surgery, you can figure out how much it will cover and how much you will have to pay out of pocket. It also helps you find a surgeon or center that takes your insurance and fits your budget. Here’s how to find out if your insurance will pay for plastic surgery:
Read the summary of perks and coverage that comes with your health insurance plan. This is the best way to find out whether or not your insurance will pay for your plastic surgery. When you signed up for your health plan, you should have been given a plan outline. If you don’t have it, you can ask your insurance company for a copy.
Call the office of your doctor. The office where you choose to have the surgery can also help you figure out if it will be covered by your insurance and how much you might have to pay out of pocket. Some tests and treatments may need to be pre-approved by your insurance company. This way, you’ll know ahead of time what your insurance will and won’t pay for.
Your doctor’s advice can go a long way toward getting your insurance company to pay for your procedure. When your doctor suggests surgery for health reasons instead of for looks, you have a better chance of getting coverage. Keeping track of your symptoms and visits to the doctor can also help you show your insurance company that a treatment is medically necessary.
Patients often have a lot of questions about their plastic surgery treatments and whether or not they will be covered by their health insurance. Every policy is different, but here are some answers to questions that are often asked about how insurance covers plastic surgery.
Is plastic surgery covered by Medicare?
Most of the time, Medicare will only pay for plastic surgery that is needed to fix a defect or damage or improve function. Some processes might need to be approved ahead of time. If Medicare approves a treatment ahead of time, you will only have to pay your deductible and your share of the cost.[6]
Do insurance plans from the market cover plastic surgery?
If a plastic surgery is deemed medically important, it may be covered by a plan from the marketplace. Hospital stays, including surgeries, are one of the 10 important health benefits that all plans in the marketplace must cover. Some insurance plans from the marketplace might also cover plastic surgery if it is needed to treat pain. Check with your insurance company to find out what your plan does and does not cover.
Why don’t insurance companies pay for cosmetic surgery?
Most insurance companies don’t pay for plastic surgery because it is usually a choice and not a medical necessity. Plastic surgery done only to improve a person’s looks isn’t necessary to keep them healthy, and insurance companies are more likely to pay for medical treatments that are considered important to a person’s health and well-being.
What should you do if your insurance won’t pay for your beauty procedure?
If an insurer turns down your claim for plastic surgery, you can file an appeal. You can look in your insurance contract or call your health insurance company to find out how to file an appeal. If your doctor says that your procedure is medically necessary, your claim might be accepted. If your appeal doesn’t work, you might be able to get a loan or talk to your medical provider about a payment plan.
How can a cosmetic treatment be considered a medical necessity?
Even though health plans are different, most insurers agree that a procedure is medically important if it is needed to treat or diagnose an illness or injury. If you want a cosmetic treatment to change how you look but it’s not because of a defect or injury, it’s probably not medically necessary.