Does Medical Insurance Cover Plastic Surgery?

By Trudi Bonomi March 25, 2015 24 Comments

health insurance and plastic surgery

According to the 2015 Plastic Surgery Statistics Report published by the American Society of Plastic Surgeons, over 1.7 million cosmetic surgical procedures were performed in fiscal year 2015. That’s a lot of surgeries!

Cosmetic surgery can be very expensive (average cost of cosmetic surgery), with the total cost comprised of physician fees, surgical materials (like implants); operating room costs, anesthesia, and post-surgical devices. One common question perspective patients have when considering costs is whether their medical insurance plan will cover the procedure.

Medical Insurance and Plastic Surgery

In general, each specific insurance company determines what procedures they will or will not cover. The biggest factor insurance companies consider is whether the procedure is reconstructive or cosmetic in nature. To this end many insurers use definitions provided by the American Medical Association (AMA) as follows:

  • Reconstructive surgery refers to procedures performed to correct trauma, developmental defects, infection, or disease. Reconstructive procedures focus on improving function or normalizing appearance of the patient.
  • Cosmetic surgery refers to procedures that are focused on improving the aesthetic appearance of the face or body to improve a patients’ appearance or self-esteem.

Many insurance companies, however, can interpret the above definitions differently depending on the specific procedure and situation. For example, the circumcision of boys was universally covered by insurance companies a decade ago. Today, more and more insurance companies are declining coverage as they consider circumcision to be cosmetic.

Due to these variances it is very important to contact your insurance provider and discuss how your procedure will be classified. While plastic surgeons (and their billing representatives) can counsel you on the potential for insurance coverage it’s always best to go to the source. If insurance will cover the procedure you want, you will have to schedule a consultation with your plastic surgeon to evaluate your case and provide a diagnosis and treatment plan.

With that disclaimer aside, here are some procedures that your insurance may cover:

Rhinoplasty

Some insurance providers will cover septoplasty for patients who have a deviated septum that is disrupting their breathing. Many times your surgeon can also complete a rhinoplasty procedure at the same time as your septoplasty. While these two procedures are billed separately (medical insurance will only cover the septoplasty portion), many patients realize significant savings as portions of the surgeons fees and operating room costs are assumed by the insurance company.

Breast Reduction

Many insurers will cover breast reduction as long as the patient has a long documented history of back, neck, or shoulder pain that is not reduced after periods of physical therapy. However, many insurance companies require at least a pound of tissue to be removed from each breast in order for the procedure to be covered. For men, gynecomastia surgery may also be covered but it has a different set of guidelines than breast reduction for women.

Eyelid Surgery

Blepharoplasty procedures may be covered by your insurance if the droopy skin around the eyelids is causing vision related issues. Typically a field of vision exam or other tests will have to be done to prove a patient’s vision will improve from the procedure.

Ear Surgery

Otoplasty may be covered by your policy as long as the procedure is done to correct ears deformed through disease, injury, or birth.

Finally, you will need to contact your insurance company to make sure your chosen plastic surgeon is an in-network provider. Here at Westlake Dermatology Dr. Chuma Chike-Obi is an in-network plastic surgeon with most major insurance carriers.


Trudi Bonomi

Trudi Bonomi is a Cosmetic Consultant with Westlake Dermatology & Cosmetic Surgery. She has been with the practice since 2007. Trudi provides personal consultations with patients regarding breast augmentation, liposuction, facelift, and many other plastic surgery and laser procedures.


24 Responses to “Does Medical Insurance Cover Plastic Surgery?”

  1. kendrick says:

    Great info, hoping my current insurance (Aetna PPO) will cover eyelid surgery as my vision is partially obscured. Is it best to go through my surgeon or should I call my insurance myself?

    • WD Staff WD Staff says:

      Hi Kendrick, Thanks for reading our blog and submitting your question. While your provider can call your insurance to do some research we would also recommend you to call them directly as well. You can ask them about coverage for your current plan and circumstances.

      Hope that helps and we wish you well!

      Thanks,
      WD Staff

  2. Hemmings says:

    Hey, I am for the first time here. I came across this board and I find It truly useful & it helped me out much. I hope to give something back and aid others like you aided me.

    • Catherine says:

      Can you please share any info you have that will help me with this acne and ugly pigmentation, large pores etc. On my face and scarring from a heating pad burns on my shoulder blades. I am a new widow and my husband recently passed away in my arms after a 4yr cancer battle that literally took EVERYTHING we owned from our home and everything inside it of any value as well as our vehicles and all our lifetime savings. I feel like I’ve aged 10 years from the stress as well.
      Thank you kindly and May God Bless You and Your family.
      Sincerely,
      Catherine

  3. Grafton says:

    Useful information. I’m glad I found this post, thanks for sharing it

  4. Jackie says:

    Very helpful

  5. Lee says:

    Unfortunately my insurance will not cover my procedure, can you provide any tips on financing options?

  6. Ryan says:

    Thanks for the details provided! I was researching for this information for a long time, but I was not able to find a dependable source until I found your post.

  7. Brock says:

    Valuable information! Thanks for sharing.

  8. Vanessa says:

    I had the gastric bypass done and I’m very depressed with my body.I’m only 28 years old and I’m a mother of 2.. I have allot of saggy skin in my arms legs and stomach ..I also lost allot of breast..I wounded what my insurance might cover so I can get the skin removed and to see if I can get my breast done.But I don’t know where to go..Any advice would be greatly appreciated

    • WD Staff WD Staff says:

      Hi Vanessa, issues related to excess or sagging skin is quite common following gastric bypass. We see a lot of patients in similar situations after significant weight loss. So know that you are not alone regarding those feelings!

      Unfortunately most insurances will not cover cosmetic procedures to treat those issues. A good alternative to look into might be financing (more on that here: https://www.westlakedermatology.com/blog/financing-options-for-cosmetic-surgery). Depending on the surgeon/provider, there are even 0% interest loans with long terms (2-3 years) so depending on the total cost of your procedure you might be looking at a small monthly payment.

      I hope that helps!

      Thanks,
      WD Staff

  9. Brinlee says:

    I had knee surgery a year ago and a half ago and my scar did not heal very well. The scar is very thick and still very dark right across the top of my knee cap. I am wondering if this can be covered by insurance or not? Thanks!

    • WD Staff WD Staff says:

      Hi Brinlee, while coverage can differ by policy unfortunately most companies categorize scar minimization treatments as “cosmetic” and thus will not cover them. Typically the only exceptions made are for scarring that hinders movement or dramatically affects ones quality of life.

      That being said it might be a good idea for you to see a provider (in-person consultation) and get their assessment. You could also contact your insurance provider to see about getting it covered, especially since the scar does stem from a medical surgery. They might make an exception given that circumstance.

      Thanks,
      WD Staff

  10. Brittany says:

    Do you mind telling me a great insurance company to go through for something like a Brazilian butt lift? I have no credit so it’s very hard for me to get approved for anything that the plastic surgery places offer.

    • WD Staff WD Staff says:

      Hi Brittany, thanks for reading our post and submitting your questions. Unfortunately most insurance companies will not cover a procedure like a Brazilian butt lift as they consider that strictly cosmetic. You can always call around but we have not seen any major insurer willing to provide coverage for that particular procedure.

      Sorry we can’t be of more help. However, if you do find a provider please come back and let us know!

      Thanks,
      WD Staff

  11. Ashley says:

    Hi, I have severe asymmetrical breast one breast a C the other a DD..it’s really embarrassing do you think insurance would cover it?

    • WD Staff WD Staff says:

      Hi Ashley, Thanks for submitting your question. We’ve had similar cases where the insurance provider did cover all or part of the procedure. Again, in those cases the insurance company deemed the procedure as medically necessary. And different insurance companies (and even policies provided by the same company) may treat this determination differently.

      Your best bet would be to contact your insurance company to discuss the potential for coverage. Hopefully they will direct you to get a consultation with a surgeon and assess the procedure as necessary.

      Thanks
      WD Staff

  12. Wendy says:

    I have a scar on the left side of my chin which pushes all the rest of the chin where you would have a double chin over to the other side and middle so it looks like I have a double chin and it’s very noticeable. I hope I’m explaining it to you correctly. Would my insurance company cover a procedure to get rid of that double chin look in the front n other side due to the scare.
    Thank you

    • WD Staff WD Staff says:

      Hi Wendy,

      Thanks for reading our post and submitting your excellent question! Your best option would be to call your medical insurance and discuss this matter directly with them. Specifically, ask if you can see a dermatologist/plastic surgeon for an assessment and referral. Then you can be assessed to see if the issue is medically necessary (which will improve your chances of coverage).

      I hope that helps!

      Thanks again,
      WD Staff

  13. Savannah says:

    Hi,

    I have been doing research on possibly inquiring about a labiapasty procedure and am not sure if insurance companies cover these. Since I reached maturity, I have had so much discomfort walking, exercising, and also with my partner because I have 3-4 inch labia (sorry if too much information). On top of this, though, the way it looks has always made me self conscious and insecure. If you could help me out, I’d really appreciate it!

    • WD Staff WD Staff says:

      Hi Savannah,

      Thanks for this great question! We have had a few cases where medical insurance did cover part of the cost of a labiaplasty procedure for the patient. In each of these cases the patient proved a medical necessity for the procedure. One caveat, however, is that each insurance policy is different. So the only real way to determine this would be to discuss it with your insurer.

      If your insurance will not cover the procedure most surgeons do offer no interest financing. That may be another option you could look into.

      We hope that helps!

      Thanks,
      WD Staff

  14. Adriana says:

    Hello,
    I had a double lumpectomy done a couple of years ago and it left my Areola’s with massive scars and changed the shape of them somewhat.i also found that with the surgery, I have excess skin at the top of my breast making them sag- something that I’ve never had before that causes a lot of pain In my breasts. Will insurance cover getting sagging skin removed in this case?

    • WD Staff WD Staff says:

      Hi Adriana,

      Thanks for reading our post and submitting this great question! First off, we tell all commentators on this blog to contact their insurance directly. The insurance company has sole power in determining what they will cover (i.e. deem “medically necessary”).

      That being said, it sounds like your case does have long-term medical implications.

      So we would recommend contacting your insurance provider and discussing the situation. Hopefully they will have you see a physician in order to determine the necessity (and coverage).

      Thanks,
      WD Staff

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