Elective Surgery vs. Procedures
covered by Insurance
Now that you are exploring the cost, price, financing, and
other payment options associated with plastic or cosmetic
surgery, it is important to know
if your procedure is covered by traditional insurance.
The rule of thumb is that if
the service is medically necessary or appropriate to treat
a medical
condition or ailment, then the service is generally covered
by insurance.
In the case of plastic surgery, insurance
pays for those cases that are reconstructive due to malformation
or injury.
Additionally, if the case is to restore
proper functioning, to relieve pain or suffering, or treat
other medical condition, there very well may be insurance
coverage.
Examples:
- Reconstructive Breast Surgery or Breast Reconstruction
due to Cancer.
- Blepharoplasty for restoring eye sight due to extreme
drooping of eyelid.
- Rhinoplasty to aid in proper breathing, or sometimes
to correct a break from a previous injury
- Breast Reduction surgery for reducing large breasts
that lead to extreme pain and the disruption of daily tasks
If you're in doubt about your eligibility
for insurance coverage, contact your insurance company for
guidelines and rules, or your employer
for a copy
of
your
summary plan description.
If you need to appeal a coverage
determination, make sure you understand rules and ask
your
physician to write a letter explaining how your case or procedure
is medically necessary or how it fits the particular coverage
criteria of your insurance company.
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