Does Health Insurance Cover Plastic Surgery?
As increasing numbers of patients seek physical perfection nowadays, plastic surgery has become a booming business. From drooping eyelids and sagging breasts to excess pounds and acne scars, people are constantly seeking surgical fixes for their cosmetic problems.
But all of these relatively quick fixes can be very expensive. Unfortunately, most plastic surgery procedures are not covered by health insurance. Very few procedures that are deemed reconstructive or essential might be covered.
For instance, the law requires insurance companies to cover breast reconstruction after cancer-induced mastectomies. Similarly, procedures such as corrections of birth defects such as cleft palates are also usually covered.
How much does plastic surgery cost?
The field of plastic surgery is vast and tackles physical imperfections of varying kinds, all at different costs. According to WebMD, most elective surgeries are not covered by insurance. So be prepared for out-of-pocket expenses.
Citing a 2011 survey by the American Society of Plastic Surgeons, WebMD found that surgeon’s fees vary depending on the procedure. On average, a rhinoplasty costs $4,422; eyelid surgery or blepharoplasty costs $2,741; cheek implants cost $2,989; a facelift or rhytidectomy costs $6,426; and a brow lift costs $3,309.
Less-invasive procedures such as Botox costs $365 while chemical peels cost $653, laser skin resurfacing costs between $2,169 and $1,223, collagen injections cost $520, and lip augmentation costs $1,650.
Besides surgeon’s costs, patients also need to factor in anesthesia and operating room costs, hospital stay, medication, and other related expenses. In other words, the final bill could be 50%-100% higher than the surgeon’s fees mentioned above.
What kinds of plastic surgery does health insurance cover?
Simply put, health insurance does not cover any procedure that is considered elective self-improvement or “vanity” surgery. If you are unsure about your coverage, you must talk to your plastic surgeon and your health insurance company before embarking on any process.
Besides mastectomies and birth defects such as cleft palates, there are a few other plastic surgery procedures that might be fully or partially covered. But your plastic surgeon needs to sign off on the right documents.
Reconstructive surgeries for burn patients are likely to be covered, as are procedures required to correct injury from accidents. Again, read the terms and conditions to find out about deductibles and co-pays.
In some cases, breast reductions might be covered if your plastic surgeon establishes that they are the cause of chronic pain that impacts your quality of life. Similarly, an eyelid lift in cases of extreme droop that impedes vision is also likely to be covered.
You may also be able to get partial coverage for a portion of your plastic surgery that is not deemed as cosmetic. For instance, if you are getting a nose job or a rhinoplasty along with the correction of a deviated septum, you are likely required to pay for the nose job only. This is because a deviated septum is known to cause increased infections in addition to impeding normal breathing; therefore, it is deemed a medical procedure requiring coverage.
Given the vast array of terms and conditions in health insurance policies, it is best that you work closely with your surgeon and health insurance company to cover all the bases. This will help you avoid any unpleasant billing surprises and will educate you about your rights under the law.
What are my options for payment for any plastic surgery procedure?
As stated above, the final decision for any full or partial payment for any surgical procedure lies with your health insurance company. So it is imperative that you talk to your health insurance company or your benefits advisor in your company if you are getting work-based insurance.
While health insurance professionals are meant to help you in your decision, it is very important that you educate yourself. So, before talking to your health insurance company, carefully go through your health insurance plan. Make notes about your coverage terms, deductibles, and co-pays. An educated consumer is a better advocate! Make sure you get everything in writing.
If you are likely to get full or partial coverage, discuss the procedure with your plastic surgeon. Ask them for a detailed surgical plan. Most plastic surgery procedures require pre-authorization, so make sure you get the right supporting documents. Read them carefully and then submit them to the health insurance company in a timely fashion.
Once the terms of coverage are clarified, the health insurance company will pay for the required portion after you meet all the deductions and co-pays.
Depending on the surgery, if it is deemed purely elective, then you are required to pay all costs including surgeon’s fees, hospital and surgical costs, and more.
Given the rising popularity of elective plastic surgery, you can talk to your surgeon about any ‘specials’ or discounts that they offer. Indeed, increasing numbers of plastic surgeons are extending financing plans where you can make monthly payments with no or low interest charges.
You can also find low-cost procedures at hospitals, which are creating combination packages for plastic surgery. These operations are done by newly minted plastic surgeons that require lengthy surgical training. While this might be worrisome for some patients, they should know that each surgery is supervised by an experienced and Board-certified plastic surgeon.
If you are seeking an elective plastic surgery procedure, you will be surprised at the number of payment options available to you. So do your research and examine all the offers in the plastic surgery market!