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Role of 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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