Plastic Surgery Procedures & Health Insurance Coverage: What You Need to Know

Plastic surgeon reviewing health insurance information following plastic surgery procedureWhen discussing plastic surgery procedures with potential clients, one of the most common questions we are asked is: Will the procedure I’m considering be covered by my health insurance?

This is a difficult question to answer, as there is no ‘one-size-fits-all’ answer that applies to all individuals. There are a variety of factors that influence whether or not the cost of a specific plastic surgery procedure will be covered by an insurance plan.

In fact, the same procedure may be covered by insurance for some people but not for others.

While we may not be able to give you a definitive answer about whether or not your procedure will be covered, we can point you in the right direction when it comes to understanding a number of important things related to plastic surgery and health insurance coverage, including:

  • How to find out if your procedure will be covered by your insurance
  • Plastic surgery procedures that are commonly covered by health insurance
  • Plastic surgery procedures that typically are not covered by health insurance
  • Why some procedures are covered while others are not
  • How to pay for your procedure if insurance will not cover the cost

Looking for some insight on one or more of these topics? Read on to learn about what to expect when it comes to determining if your procedure will be covered.

How Do I Find Out If the Procedure I’m Considering is Covered by My Insurance?

Before you move forward with scheduling a plastic surgery procedure, you’ll want to know for sure whether or not the procedure will be covered by your health insurance.

The best way to go about determining with certainty that the procedure will or will not be covered is to contact your insurance company directly to find out if your policy includes coverage for plastic surgery procedures. If it does include coverage for plastic surgery, you’ll want to confirm that the coverage applies to your specific procedure, scenario, and surgeon.

Ask specific questions so you have a detailed explanation of the insurance coverage you can expect. You’ll want to ask for the details from the insurance representative in writing so you can refer back to the information following the procedure, and be prepared in case there are changes in what seems to be covered under your policy after the fact.

Which Plastic Surgery Procedures Are Typically Covered by Health Insurance?

If you’re just doing a preliminary investigation into plastic surgery and insurance coverage, you’re probably curious to know if there are any procedures that are commonly covered. While all insurances and scenarios vary, we have seen some procedures covered by insurance in the past.

In many cases, the plastic surgery procedures that have been covered were either reconstructive or medically necessary to preserve a patient’s quality of life. Keep in mind that insurance companies have differing definitions and interpretations of what these terms mean.

Some of these reconstructive or medically necessary surgeries have included:

Keep in mind that these surgeries need to be deemed medically necessary in order for your insurance company to consider covering them. Again, whether or not your specific procedure will be covered is entirely up to your insurance company and how they evaluate the procedure.

Some of the procedures listed above may be covered for some individuals but not for others based on the necessity of the procedure, the insurance policy, and other factors. It’s never safe to assume that just because you know of someone who was able to have a certain procedure covered by insurance you’ll be able to undergo the same procedure and have it covered by insurance as well.

What Procedures Are Not Usually Covered by Insurance?

In most cases, plastic surgery procedures that are considered purely cosmetic are not covered by health insurance. Typically, insurance will not pay for the costs associated with procedures that are elective or optional and are not considered to be medically necessary to maintain quality of life or improve bodily function.

As such, plastic surgery and cosmetic procedures that are not usually covered by health insurance include:

Again, it’s important to keep in mind that your insurance company has full discretion when it comes to determining what they consider to be cosmetic and elective in terms of plastic surgery procedures.

Why Are Some Plastic Surgery Procedures Covered By Insurance While Others Are Not?

As mentioned previously, there are a number of factors that impact whether or not a plastic surgery procedure will be covered by health insurance.

Your specific health insurance policy may or may not include coverage for plastic surgery. As such, coverage can depend on the provider and policy.

Additionally, the reason for the plastic surgery is typically one of the deciding factors for insurance companies. If a procedure is elective or optional, it likely won’t be covered. If the procedure is considered to be purely cosmetic, most health insurances won’t cover the cost.

On the other hand, if a procedure is considered to be medically necessary or reconstructive in nature to correct defects or abnormalities caused by certain conditions, diseases, illnesses, or accidents, that procedure may be covered by health insurance. Your insurance company will be the one to determine whether or not your procedure is considered cosmetic and elective or medically necessary.

Given that the circumstances surrounding the procedure, the type of procedure, the insurance policy coverage, and other factors impact whether or not the surgery will be covered, it’s incredibly important to work with your insurance company to know what to expect. In most cases, they will be the ones to ultimately determine what will be covered in your specific situation.

If Insurance Won’t Cover the Cost of My Plastic Surgery Procedure, What Are My Options?

Plastic surgery procedures can be expensive, which is why so many individuals are hopeful that health insurance will cover at least a portion of the cost. Given that cosmetic procedures typically are not paid for by insurance, many patients wonder what their other options are when it comes to financing their plastic surgery.

Often, plastic surgeons offer a number of payment options, and sometimes even flexible financing options, for patients needing to pay for their procedures out of pocket.

At Garcia Plastic & Hand Surgery, we offer a number of flexible payment options for cosmetic procedures. You can learn more about those options here, or give our office a call to discuss which payment plan might be right for you.

Have Additional Questions About Plastic Surgery Procedures and Insurance Coverage?

As we mentioned, your insurance company is the best resource when it comes to determining whether or not a specific plastic surgery procedure will be covered. However, if you’d like to set up a consultation with us to discuss your plastic surgery goals before reaching out to your insurance company, we’d be more than happy to meet with you!  

We’ve been providing high quality plastic surgery and cosmetic surgery services to clients in Glens Falls, Saratoga, the Adirondacks and beyond for more than a decade! If you’re ready to take the next step towards looking and feeling your best, we’d be happy to partner with you on the journey.

Schedule an appointment with us today! Give us a call at 518-793-0475 or contact us online to get the conversation started.

Looking for additional information about cosmetic procedures and what to expect when it comes to plastic surgery? Be sure to check out the cosmetic procedures section of our blog for valuable insight from our experienced team.

Still not sure if plastic surgery is the right choice for you? Learn more about important things to consider and factors to weigh as you approach the decision.