Reconstructive surgery is covered by most health insurance policies, although the specifics of coverage may vary greatly. Some carriers may fully cover reconstructive procedures, others may pay only a portion of the cost.
Cosmetic surgery, however, is usually not covered by health insurance because it is elective and not considered a medical necessity. Some plastic surgeons accept major credit cards or offer financing programs that allow patients to make manageable monthly payments for cosmetic surgery.
Keep in mind that there are a number of "gray areas" in plastic surgery that sometimes require special consideration by an insurance carrier. (See Table I) For example, eyelid surgery -- a procedure normally performed to achieve cosmetic improvement -- may be covered if drooping eyelids obscure a patient's vision. In assessing whether the procedure will be covered, the carrier often looks at the primary reason the procedure is being performed: is it for relief of symptoms or for aesthetic improvement?
Table I: Procedures That May be Covered by Insurance*
Abdominal surgery, when it is performed to:
- Alleviate health problems, such as back pain, sores, rashes, hernia;
- Restore the ability to walk normally.
Breast surgery, when it is performed to:
- Correct congenital asymmetry;
- Reduce overly-large breasts that are causing health problems (shoulder grooving, neck and back pain, etc.);
- Reconstruct a breast lost to disease;
- Correct congenital absence of breast;
- Reduce over-developed male breasts -- gynecomastia.
Ear surgery, when it is performed to:
- Correct congenitally-deformed ears;
- Reconstruct ears that are deformed by disease or injury.
Eyelid surgery, when it is performed to:
- Correct drooping upper eyelids that are obscuring vision;
- Correct out-turned or in-turned lower eyelids.
Facial surgery, when it is performed to:
- Correct an asymmetrical appearance caused by facial paralysis;
- Treat conditions affecting the facial muscles, lips, and cheeks;
- Treat traumatic deformities;
- Correct head and neck deformities.
Hand surgery, when it is performed to:
- Treat carpal tunnel syndrome;
- Correct Dupuytren's contracture, treat tendon and nerve injuries;
- Correct syndactyly (fused fingers) and other congenital deformities.
Nasal surgery, when it is performed to:
- Correct deformities resulting from birth defects or disease;
- Treat injuries or nasal deformities that may affect breathing.
* Numerous individual circumstances affect whether a procedure is covered. Patients should obtain written verification of coverage and prior authorization for the treatment from their carriers.