Will My Insurance Cover My Plastic Surgery Procedure?

A common question that many people ask during plastic surgery consultations is, “Will my insurance cover this procedure?” Unfortunately for most people the answer to that question is no, but an increasing number of insurance policies are allowing some plastic surgery coverage, so check with your individual plan for more details. That being said, there are some procedures that are covered by most medical insurance policies, but they must meet certain criteria to qualify. If you’re considering plastic surgery and would like to use your medical coverage to pay for part of it, check out this list of procedures to see if you could qualify. 

Breast reduction

Breast reduction (for both men and women) is actually commonly covered by insurance. This is because, for women, large breasts can be a medical issue. To qualify for insurance coverage, most insurance plans require the patient to be at least a DD cup or larger, but exception may be made for more petite women. Large breasts can often cause neck, back and shoulder pain as well as uncomfortable rashes and skin infections due to moisture that becomes trapped on the skin between the breast and abdomen. For men with enlarged breasts (called gynecomastia) some insurance plans may cover the cost of reduction, especially in teens and younger adults.

Panniculectomy

Panniculectomies are surgeries to remove excess skin from a patient who has lost a drastic amount of weight. Often when the body carries excess weight, the skin stretches to accommodate the extra body mass, but it may not be able to shrink back once the body weight is lost. This creates extra skin, which can be painful for the patient to carry around and can restrict their physical abilities. It can also be prone to painful recurring rashes and skin infections. If the patient is prone to any of these complications, a panniculectomy may be covered by insurance.

Rhinoplasty

You may have heard of celebrities whose transformed noses were the result of a deviated septum correction rather than rhinoplasty. This common procedure may be partially or fully covered by insurance. While rhinoplasties on their own will probably not be covered, if the procedure also includes repair to the septum or any structural deformities or damage inside the nose, insurance may cover at least part of the procedure. It is important to note that in many cases insurance may only cover the medically necessary part of the procedure, leaving the patient to pay for anything their provider deems cosmetic.

Breast Augmentation

Cosmetic breast augmentations are almost never covered for first-time patients, but for reconstructive purposes (such as following a mastectomy) many policies will cover breast augmentation. In the case of mastectomy patients, every policy is legally required to fully cover this procedure. Breast augmentations may also be covered following a previous botched augmentation or to replace a ruptured implant from a previous surgery. Please note that most policies will not pay for new implants if older cosmetic implants rupture, but you may be able to obtain a new implant free of charge through your implant manufacturer’s warranty.

Blepharoplasty

Blepharoplasties, or eyelid lifts, are considered cosmetic if they are done to make patients look younger or to change the shape of the eye. However, there are many cases where they are considered medically necessary. If the skin of the eyelid begins sagging or stretching, obstructing the patients vision, many insurance policies will cover the procedure.

Gender reassignment surgery

Gender reassignment surgeries are becoming more common and appearing in more insurance plans. For patients with “gender dysphoria,” many states require coverage of surgical procedures, hormones and psychological treatment related to this condition. Consult your individual policy to see which, if any, elements of gender reassignment are covered by your provider.

If you are considering any kind of plastic surgery procedure and would like to know if some or all of your procedure may be covered by your medical insurance plan, consult your plan directory or call the customer support number on your insurance card. If you believe your condition may qualify for insurance coverage, speak to your surgeon to see if your surgery may be covered. To set up a consultation with Dr. Chau, please give his office a call at 888-966-9471.

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