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:
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
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.