Cosmetic surgery is an elective procedure that is not typically covered by regular health insurance policies. This is because it is not considered a medical necessity. However, there are certain circumstances in which insurance may cover the cost of cosmetic surgery. It all depends on the individual's situation and the insurance company's criteria for coverage.
When it comes to plastic surgery, the question of whether or not it is covered by insurance often comes down to what is considered “aesthetic” versus “reconstructive”. Procedures that are purely cosmetic, such as a facelift to treat the signs of aging, are not eligible for insurance coverage. However, breast augmentation and breast reduction surgery may be covered in certain cases. Breast reconstruction surgery may be covered by insurance if it is deemed medically necessary.
This includes a review of previous reconstructions and a determination of whether or not the desired surgery will improve the aesthetic result. Breast implant revision surgery may also be covered by insurance if a doctor determines that the implants are defective. In addition, breast reduction surgery may be covered by insurance if it is done to treat discomfort or other medical issues. Insurance companies often use cup size as a guideline when determining coverage, and patients should document their symptoms and any non-surgical measures taken to alleviate them.
Adolescents and young adults are more likely to receive coverage than older adults. Panniculectomy, a surgical procedure to remove excess skin and fat from the abdomen, may also be covered by insurance in certain cases. The law continues to evolve in this area, so it is important for patients to read their plans carefully and work closely with their insurance company's customer service representatives to determine if their desired procedure will be covered. At Après Plastic Surgery in Portland, OR, the expert team is dedicated to providing exceptional care and helping patients decipher the sometimes confusing world of insurance coverage when it comes to cosmetic surgery. The American Society of Plastic Surgeons (ASPS) offers a recommended criterion for distinguishing between a cosmetic surgery procedure and a plastic or reconstructive surgery that providers can use when explaining treatments that have a dual aesthetic and functional purpose. Ultimately, whether or not a procedure is covered by insurance depends largely on several factors. It is important for patients to understand their options and work closely with their doctor and insurance company to determine if their desired procedure will be covered.
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