Financing and Insurance for Cosmetic Surgery
When it comes to paying for plastic surgery procedures, there are a variety of factors you need to consider. Cosmetic treatments are often expensive, but financing and insurance can minimize your out-of-pocket costs. It is important to keep in mind that insurance does not always cover plastic surgery. You will need to prove a medical necessity and meet all of your insurance provider’s requirements. However, your plastic surgeon may provide third-party financing options to help cover your costs.
Health Insurance and Plastic Surgery
Depending on the type of surgery you need and the rules set by your insurance company, your health insurance may cover a portion of your treatment. Most procedures are divided into two categories:
- Cosmetic
- Reconstructive
In each category, there are some procedures that are medically necessary and others that are not. Determining which category your treatment falls under is essential to finding out whether your insurance will cover it. While each provider varies in coverage, most insurance plans do not pay for purely cosmetic treatments.
Deciding What Is Medically Necessary
Insurance coverage can vary greatly when it comes to plastic surgery. However, most companies follow definitions from the American Medical Association (AMA) and the American Society of Plastic Surgeons (ASPS).
These organizations define cosmetic surgery as the reshaping of normal bodily structures to improve self-esteem or appearance. Reconstructive surgery, in contrast, is performed on abnormal structures caused by:
- Congenital defects
- Developmental abnormalities
- Trauma
- Infection
- Tumors
- Disease
The goal of a reconstructive surgery is to improve the function of a certain part of the body or to create a more normal appearance. What is considered cosmetic or restorative depends entirely on your insurance company's interpretation. For example, some companies will cover procedures to correct a condition that has a negative impact on your daily life, while others will not.
Common Procedures Sometimes Covered by Insurance
Abdominal Surgery
In some cases, insurance companies will cover an abdominoplasty or liposuction if they are necessary to improve health problems, such as sores or back pain, or to help improve a patient’s ability to walk properly.
Breast Surgery
Certain types of breast surgery may be covered by insurance. Some companies cover breast reduction surgery for excessively large breasts that cause physical symptoms and hinder your ability to perform daily tasks. Breast reconstruction surgery is often covered as well.
Ear Surgery
Surgery to correct ears deformed by birth, disease, or injury may be covered.
Eyelid Surgery
Drooping eyelids can inhibit your ability to see. If this is the case, your insurance company may cover a blepharoplasty, or upper eyelid surgery, to remove excess skin and restore proper vision. However, any additional treatments performed for cosmetic purposes will likely involve out-of-pocket fees.
Facial Treatments
Certain facial surgeries or non-surgical treatments have medical uses and can qualify for insurance coverage. For example, BOTOX® can be an effective way to treat migraines and temporomandibular joint (TMJ) disorder. In addition, facial surgery that corrects the effects of paralysis or other deformities may be covered by insurance.
Hand Surgery
Some plastic surgeons perform surgery to treat carpal tunnel syndrome, nerve injuries, fused fingers, or other issues. These procedures are sometimes covered by medical insurance.
Nasal Surgery
Medical nose jobs to treat concerns such as a deviated septum are commonly covered by medical health plans. You may need to work with an ear, nose, and throat doctor (ENT) to build a case that a reconstructive rhinoplasty would improve your health. If you choose to add cosmetic aspects to this procedure, however, you will likely need to pay for these treatments out of pocket.
Conservative Measures and Objective Tests
Many insurance companies now consider whether other types of treatment were performed before surgery. Providers often require patients to try conservative measures first, such as physical therapy or medication, before they will cover surgery. Basically, you need to show the insurance company that you tried other alternatives and nothing worked. This step is known as failure of conservative measures.
In addition, your insurance provider may require objective tests be performed. For example, if you are seeking coverage for upper eyelid surgery, you may need to undergo a visual field test to demonstrate that your vision is obstructed. They may also ask for photographic documentation of your test as further proof.
How to Find out If Your Procedure Is Covered
Get an Accurate Estimate
Schedule a consultation with a plastic surgeon for a detailed estimate of the cost of treatment.
Contact Your Plan Administrator
Get in touch with your insurance company directly and ask them about your coverage as it relates to plastic surgery procedures.
Ask about Your Deductible
A deductible is a specified amount of money you must pay before your insurance will pay a claim. Find out what your deductible would be in the event that you are covered.
Find out about Maximum Coverage
Some insurance companies cap the amount they are willing to pay for a certain procedure. Ask about the maximum amount payable and whether they expect you to pay for a certain percentage of the procedure.
Investigate Related Costs
You may have additional fees and expenses in addition to the actual surgery. Find out what related medications and services, such as pain killers or compression garments, would be covered.
Get the Details in Writing
Never assume anything is covered unless your insurance company confirms it. Make sure you get the confirmation in writing so you are not surprised later.
Financing Your Procedure
Many plastic surgery practices partner with third-party financing organizations to help patients pay for their treatments. Cosmetic procedures are often expensive, and without insurance coverage, it can be difficult to pay for treatment out-of-pocket. Companies such as CareCredit® provide flexible financing plans which can minimize the initial financial burden.
Schedule a Consultation
The best way to find out about financing and insurance is to schedule an appointment with a plastic surgeon. After your initial consultation, your doctor can give you an estimate of the cost of your procedure and work with you to figure out your coverage and financing options.
