Is Cosmetic Surgery Covered by Insurance? An Expert's Guide

Cosmetic surgery is generally not covered by health insurance, but there are exceptions. Many patients will work with an outside funding company to set up affordable monthly payments. In some cases, plastic surgery procedures that can be classified as "medically necessary" may be part of insurance policies. The American Medical Association (AMA) defines "cosmetic surgery" and "reconstructive surgery" used by health insurance companies to determine coverage. In general, procedures that are purely aesthetic in nature will not be covered by insurance. However, if a procedure has a dual aesthetic and functional purpose, it may qualify for coverage. For example, ageing eyelids can affect vision, so an upper eyelid blepharoplasty may be considered medically necessary to correct the problem. Lower eyelid blepharoplasty is more difficult to classify as a functional procedure. Gynecomastia surgery (male breast reduction) is also difficult to classify as a functional procedure, but the American Society of Plastic Surgeons (ASPS) has compiled a set of guidelines that cover pain and discomfort, suspected malignancy, and more. Unlike other procedures that require doctors to demonstrate that the patient participated in a trial of alternative treatments, patients with a congenital ear anomaly do not need to first experiment with non-surgical remedies. Shortness of breath, nosebleeds, and sinus problems can lead a patient to need nose surgery. After demonstrating that non-invasive alternatives are not effective, insurance may cover part or all of the procedure. Medically, the surgical procedure that corrects a deviated septum (a common cause of respiratory problems) is known as septoplasty and is almost always covered by insurance. In some cases, a rhinoplasty that improves the shape or aesthetics of the external structure of the nose may be considered medically necessary. It is important to consult with a board-certified plastic surgeon to determine if your preferred surgical procedure could qualify for insurance coverage under your health plan. Private insurance plans will usually cover some of the costs associated with surgery considered medically necessary, but they may not cover the costs of the surgery itself. Cosmetic surgery procedures are generally not covered by provincial health plans.