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Does Health Insurance Pay For Your Cosmetic Surgery?

The cosmetic surgery industry has steadily grown over the years, and more and more people opt to go for cosmetic procedures to enhance their beauty. But this can make a big dent in your bank balance. Most of us do not have any idea whether our health insurance can pay for this procedure or not. It actually depends on a few terms and conditions which gets reviewed by the insurance company, who then decide if you are to get any coverage or not. Sounds tricky for sure. However, if you are familiar with the clauses, it might be easier for you to understand in which category your surgery might fall under.

A report says that in the USA alone, people spent $16 billion on plastic surgery in 2016 alone which means in the last two years, the amount has probably increased. The procedure itself is quite expensive and add to that the doctor’s fees, patients will definitely end up shelling a substantial amount. Now, let’s learn the deciding factors for insurance companies.

When Does Health Insurance Cover Plastic Surgery?

Unlike other procedures and medical conditions, the clauses for plastic surgery are very different. Usually, the insurance company decides based on the type of surgery — whether its cosmetic, reconstructive or required to save an essential body part. For example, if someone needs a plastic surgery in any part of their body which has been mutilated due to an accident, it might be covered by the insurance company. However, if you are doing it to enhance your beauty and nothing else, it might not be considered at all.  According to the AMA (American Medical Association) and the American Society of Plastic Surgeons (ASPS) here are the two conditions:

1. Reconstructive surgery is done to change abnormal structures caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease.

2. The surgery is needed to reconstruct normal structures on the body to improve the self-esteem or appearance of a patient.

Basically, surgeries that are not explicitly needed for the well-being of human bodies won’t be paid by your insurance company. The circumcision of infant boys was earlier paid by the companies. But now, the rules have changed, and they are not covered anymore because this procedure is not crucial for survival, and is hence considered cosmetic.

Plastic Surgeries That Fall Under Procedures Covered By Insurance

 

Here is a list of surgeries that might be covered by your insurance company even though they are plastic surgeries.

Breast Surgery: Some people are born with one breast, while others lose it due to a medical condition, needing reconstruction. In some cases, women need surgery for asymmetrical breasts or breast reduction – all these are valid reasons to get insurance benefits on cosmetic breast surgery. Even men can get coverage if they want to reduce unusually large male breasts.

Eyelid Surgery: With age, our skin sags, and there are certain areas in our body where it becomes conspicuous. For example, some people get extremely droopy eyelids that even causes vision problems while others might have eyelids turned in abnormally. All these can be corrected via surgery which is covered by insurance.

Facial Surgery: If there are deformities on the face due to facial paralysis, surgery can correct it. Usually, it affects the facial muscles, head, or neck. Insurance does cover this kind of surgery.

Nasal Surgery: Often, nasal surgeries are performed to correct birth defects and problems caused by other diseases that result in difficulty in breathing. This is a valid cause that falls under insurance coverage.

Apart from these, abdominal, ear, or hand surgery that needs to be done due to a disease or health-related problems are also covered by your health insurance. However, if you are planning to do a rhinoplasty only because you don’t like the shape of your nose, you will have to do it out of your own pocket. Liposuction, breast augmentation, and eyelid surgery to correct aging skin are generally not covered, but in certain exceptional cases, it might be.

Since these procedures depend on the recommendation by your doctor and your insurance companies, it is best to get a consultation from both of them before you go ahead with a particular procedure. Now, it would be a big shock if you are asked to pay $10,000 for your plastic surgery when you thought your insurance has it covered. So, do your research well!

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