Medical Insurance Cover Plastic Surgery: Coverage and Costs

Medical insurance cover plastic surgery can be a complex and costly endeavor. Most health insurance plans do not cover cosmetic procedures, but some may cover reconstructive surgery.

Reconstructive surgery, however, is a different story. It's often covered by insurance if it's medically necessary, such as after an accident or to correct a birth defect.

The cost of plastic surgery can be staggering, with prices ranging from $3,000 to $50,000 or more for a single procedure.

Insurance coverage for plastic surgery can be a bit of a puzzle, but it's essential to understand the rules before you start planning your procedure. Fortunately, most medical insurance providers cover the cost of reconstruction surgery, which is done to correct defects or injuries, and provide you with the proper assistance and facilities required.

Reconstructive surgeries, such as facial reconstruction, limb salvage, and reconstruction for breast conditions, are typically covered by health insurance plans. These surgeries are done as corrective measures to ensure the appearance and functioning of the affected part of the body gets better.

However, cosmetic surgeries, like liposuction, facelift, and rhinoplasty, are not included in the health insurance plan and might require a separate cosmetic surgery insurance to cover their cost. The expense of such surgeries depends on various factors, including the amount of skin graft used.

There are some circumstances under which health insurance plans might cover the cost of medical-related cosmetic surgery, such as surgeries performed to treat congenital abnormalities, cancer and tumour treatment surgeries, injuries related to burns, and laceration surgery to treat blunt traumas or injuries.

To get your procedure approved as a surgery covered by insurance, you will need to prove that there are health issues connected to your concern. This will include attempted remediations, documented reports from specialists, and sometimes 6-12 months of documentation and treatment by a specialist.

Here are some exceptions to the rule: if a doctor says a procedure is medically necessary, most health plans will cover it. This includes procedures like breast reconstruction after a mastectomy, or skin grafting after a burn injury.

If your insurance company refuses to cover the cost of your procedure, don't be discouraged. You have options, such as talking with your doctor or physician, contacting your insurance company, or trying to save up for the procedure yourself.

Reconstructive surgery is a type of surgery that corrects defects caused by injury or disease, and most medical insurance providers cover its cost.

Fortunately, reconstructive surgeries like facial reconstruction, limb salvage, and breast reconstruction are covered by health insurance.

Cosmetic surgery, on the other hand, is not done for medical reasons and is not included in the health insurance plan.

Some examples of cosmetic surgeries not covered by health insurance are liposuction and facelift cosmetic surgery.

Hair transplant surgery is a cosmetic procedure that is in high demand, especially for patterned baldness.

The cost of hair transplant surgery depends on the amount of skin graft used.

Rhinoplasty, or "nose job" surgery, may be covered by insurance if it's done to correct respiratory or nasal issues.

However, if it's done solely for cosmetic reasons, it's not covered by health insurance.

Cosmetic surgery can be expensive, with prices ranging from hundreds to thousands of dollars per procedure. A breast augmentation costs about $3,700 per breast, while a nose job costs around $5,000.

Some procedures are more costly than others, with tummy tucks being one of the priciest at $5,800 a pop. Even minimally invasive procedures can cost hundreds of dollars per treatment, such as chemical peels at around $675 each.

If you're unsure about the cost of your procedure, be sure to check your health insurance policy. You can find a printed copy or check your insurer's website. If you're still unsure, pick up the phone and call the insurance company to ask about possible coverage and out-of-pocket costs.

Here are some examples of cosmetic surgery costs:

Keep in mind that some procedures may be covered under your health insurance plan, especially if they're medically necessary. These can include surgeries to treat congenital abnormalities, cancer, burns, or injuries.

Costs can add up quickly, especially when it comes to cosmetic surgery. A breast augmentation can cost around $3,700 per breast.

A nose job typically costs around $5,000. Liposuction, on the other hand, is priced at approximately $3,200. Tummy tucks are among the priciest procedures, with a cost of $5,800.

An eyelid lift averages just over $3,000. Male breast reduction surgery typically costs around $3,500. An otoplasty, or "ear job", can cost $3,150.

Here's a breakdown of some common cosmetic procedures and their costs:

Health insurance exceptions can be a bit confusing, but I'm here to break it down for you. There are circumstances where health insurance plans might cover the cost of cosmetic surgery, and they're not just limited to medical insurance.

Surgeries to treat congenital abnormalities, such as nasal deformities, cleft lips, and cleft palates, might be included in health insurance plans. These are often considered medically necessary and are therefore covered.

Cancer and tumour treatment surgeries are also covered under health insurance plans, which is a relief for those who need these procedures.

Surgeries performed to treat injuries related to burns, such as skin tightening, grafting, and skin rearrangement, might also be included in medical insurance.

Laceration surgery to treat blunt traumas or injuries is another example of a procedure that might be covered under health insurance plans.

Here's a rundown of some of the exceptions:

Keep in mind that these exceptions are subject to the approval of your doctor, and not all health insurance plans will cover these procedures.

To get your procedure approved as a surgery covered by insurance, you'll need to show that there's a health issue connected to your concern.

This might involve documenting attempts to address the issue through other means, such as physical therapy or chiropractic care.

You may need to provide reports from specialists, such as a chiropractor or orthopedist, and sometimes 6-12 months of treatment records.

Medicare doesn't cover plastic and cosmetic surgery unless it's needed for an accidental injury or to improve the function of a malformed body part.

Both Medicare and Medicaid allow some exceptions to their general rules. For example, Medicare covers breast prostheses and reconstruction if you have a mastectomy because of breast cancer.

Medicare Part A pays for reconstruction surgery if done in an inpatient setting, while Part B pays for it if done in an outpatient setting. Part B also pays for external breast prostheses, including a post-surgical bra.

Medicaid works similarly to Medicare, but individual states have some leeway to decide what's covered under their Medicaid programs. Yours may cover plastic and cosmetic surgery differently than others.

Expect Medicare and Medicaid to have different rules and exceptions, so it's essential to check what's covered in your specific program.

To get your plastic surgery procedure approved as a surgery covered by insurance, you'll need to prove that there are health issues connected to your concern.

You'll need to show attempted remediations, which means you've tried other treatments or solutions before considering surgery. This can include physical therapy, medication, or other non-surgical interventions.

Documented reports from specialists are also crucial, as they provide objective evidence of your condition. This can include letters from your doctor, physical therapist, or other specialist.

Sometimes, 6-12 months of documentation and treatment by a specialist, physical therapist, or other doctor, such as a chiropractor or orthopedist, is required to prove medical necessity.