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Plastic Surgery Procedures That Are Covered By Health Insurance Companies

Having a health insurance policy does not guarantee coverage against any eventuality because insurance companies only consider payment for plastic surgery depending on the health plan you have purchased and the terms and conditions of the policy. This is particularly the case in the procedure that is believed to be reconstructive and is non-cosmetic.

In 2015, Americans paid around $13.5 billion for such procedures, and most of the money spent was towards doctor’s fees. People may easily begin to believe that health insurance companies are the ones making the contributions. However, insurance companies consider different factors before they take into account the need to make a payment for a procedure of plastic surgery. Let us look at some of the factors which they consider.

When do health insurance companies consider payment for plastic surgery?

The Criteria Applied by Insurance Companies For Plastic Surgery Differs According to The Procedures.

Insurance companies have different criteria for the payment of plastic surgery procedures. It is important for the patient to understand whether the procedure will be covered by the plan they have purchased. They need to understand whether:

  • They are opting for a cosmetic procedure.
  • The procedure they are undergoing is reconstructive.
  • The procedure is essential for preserving their quality of life and body function.

It is only when the patient has answers to the questions above will the insurance company begin the process of determining whether the procedure deserves to be covered.

Health insurance policies can differ with regard to what is covered under the health plan, and the company generally adheres to a set of guidelines to determine whether a procedure is reconstructive or it can just be defined as cosmetic.

How does an individual understand whether plastic surgery is covered by health insurance?

Insurance companies generally follow the definitions provided by the American Medical Association and the American Society of plastic surgeons to determine whether a procedure should be covered or not under the health insurance plan. The two bodies mentioned in this article state that the reconstructive surgery is a procedure that is caused by congenital defects, disease, trauma, tumors and also developmental abnormalities.

The procedures needed for the mentioned problems may also include the improvement of a certain body function and give the individual a normal appearance. Cosmetic surgery is classified as reshaping the standard structures of the body making the overall appearance better and increasing and the self-esteem of a certain individual.

Health insurance companies have their own interpretations of plastic surgery.

Insurance companies have interpreted the definitions mentioned above in their own ways. Some procedures which insurance companies were paying for in the past are no longer considered as essential and have been classified as cosmetic. The insurance company issuing the policy may change the definition of cosmetic plastic surgery depending on the type of policy purchased by the patient after considering new procedures and medical treatments which have evolved.

List of plastic surgery procedures which insurance companies may consider covering:

Insurance Companies, In Most Cases, Are Following The Guidelines Provided by The American Society Of Plastic Surgeons To Determine Whether Procedures Qualify For the Payment Or Not.

Given below is a list of procedures which may be recommended by the American Society of plastic surgeons which may be covered by insurance companies:

  • Abdominal surgery to improve or to eliminate health-related problems such as back pain, hernia, sores, rashes or the ability to move and walk without problems.
  • Breast surgery which is conducted to improve asymmetry or reduce the size of large breasts which could be causing health problems, and reconstruction because of congenital absence.
  • Ear surgery which may be performed to rectify deformed ears during birth, injury or disease.
  • Eyelid surgery for the correction of drooping eyelids which may be causing problems with the vision or other issues.
  • Nasal surgery when conducted to rectify deformities from birth which could be causing problems with breathing.
  • Plastic surgery procedures may also be conducted on the face and the hands to rectify any problems which may have been caused by health issues.

Patients who need to get plastic surgery of the type mentioned above should have a discussion with their doctor to understand whether their procedure would be constructed as reconstructive surgery. The doctors can also help the patient by contacting the insurance company to get a definite idea about the procedures.

List of procedures not covered by health insurance companies:

Among men and women, the number of procedures of the cosmetic variety has increased by 325% and 538% since 1997 respectively. It cannot be denied that more people are looking to receive compensation from their health insurance providers for the procedures they decide to undergo with the belief that their plan will cover the same. However, insurance companies are reluctant to cover cosmetic surgery procedures because they don’t consider it essential or necessary to maintain the quality of life.

Some examples of plastic surgery procedures which are not covered by health insurance companies include liposuction, eyelid surgery, and breast augmentation despite exceptions being made by the insurers in circumstances that are extraordinary.

Before considering plastic surgery procedures of any kind, people are advised to have consultations with their doctors and their insurance companies to understand whether they are fully covered by the health insurance plan they have purchased.

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