What Cosmetic Surgery Procedures Are Covered By Insurance?

Just like most things we purchase or pursue in life, the cost of plastic surgery is a significant factor to consider. If you’re planning to undergo a cosmetic procedure, it’s only natural to have concerns about the financial obligations involved and the possibility of insurance coverage for some of the costs.

At Après Plastic Surgery in Portland, OR, our experienced team is committed to delivering the highest standard of care, including helping you navigate the often complicated realm of insurance coverage for cosmetic surgery.

Does insurance cover Plastic Surgery?

The answer to this question is not necessarily black and white. Whether or not a procedure is covered by insurance depends heavily on several factors. Oftentimes, the deciding factor is whether the insurance company considers the procedure to be medically necessary.

Purely cosmetic procedures, therefore, are not covered. For example, a patient who desires a facelift to address cosmetic signs of aging would not be eligible to have insurance cover the procedure.

There are some cases, however, when even cosmetic surgeries may be deemed necessary for health or functionality. For instance, many people suffer from impaired vision as a result of excess eyelid skin that droops into their field of vision. In this scenario, a blepharoplasty – or eyelid lift – may be partially covered by an insurance company.

Another surgery that can sometimes be shown to be medically necessary is a panniculectomy, or excision of the excess skin on the lower abdomen (pannus). For some after weight loss patients, this hanging skin severely impairs their mobility and even causes chronic skin rashes, irritation, and infections.

Which cosmetic surgeries are usually covered by insurance?

It is difficult to say that a specific procedure is “often” covered by insurance because coverage details and decisions can vary greatly from case to case.

Again, the determining factor of whether or not a procedure is covered by insurance typically comes down to the reason the surgery is being performed. Some of the most common cosmetic procedures that have justifiable benefits for insurance coverage consideration include:

• Rhinoplasty: in the case of problems breathing or sleeping
• Blepharoplasty: in the case of impaired vision
• Breast implant removal: in the case of breast implant-associated illness
• Skin removal surgery: in the case of chronic rash, infection, or other condition
• Breast augmentation or reconstruction: in the case of mastectomy for breast cancer

Can my nose job be covered by insurance?

Rhinoplasty, commonly known as a nose job, is an interesting case where oftentimes patients have the procedure performed primarily for medical/functional reasons but receive the cosmetic benefits of the surgery secondarily.

A large number of men and women undergo rhinoplasty to address a deviated septum, small nostrils, or other mechanical flaw, which obstructs nasal airflow and can lead to trouble breathing, difficulty sleeping, and even sleep apnea. In many of these cases, rhinoplasty will be considered a necessary procedure and, in turn, be covered by the patient’s insurer.

As a result of the manipulation necessary during rhinoplasty, the patient may also achieve a more appealing nasal contour, even though the procedure was not intended as a cosmetic one.

During your initial consultation at Après Plastic Surgery, one of our exceptional board-certified plastic surgeons will thoroughly evaluate your situation, discuss your goals and concerns, and give you a realistic idea of what results are possible with your intended procedure and if there is an opportunity to receive any insurance benefits.

How can I get my plastic surgery covered by insurance?

In the end, whether or not your surgery is covered by insurance is in the hands of your insurance provider. There are a few things you can do, though, to give yourself the best possible chance of being considered for coverage and proving that your surgery is medically necessary, including:

• Document your condition with photographs and logs.
• Keep detailed records of every visit to the doctor, hospital, or other facility that pertains to your condition. This includes any product purchases or therapies.
• Be able to show that you have exhausted all of your options to treat your condition and that surgery is the last resort.
• Obtain statements from your doctor and other medical professionals recommending that your desired surgery be performed for medical/functional reasons.
• Select a qualified, certified, and reputable surgeon and treatment facility.

The caring team at Après Plastic Surgery knows how frustrating it can be to suffer from a real condition but be unable to get coverage for treatment.

Why cosmetic surgery is not covered by insurance?

Cosmetic surgery is typically not covered by health insurance because it is considered an elective procedure that is not medically necessary. Health insurance is designed to cover necessary medical procedures that are intended to improve a patient’s health or treat an illness or injury.

Cosmetic surgery, on the other hand, is primarily performed to enhance a person’s appearance and is not considered medically necessary in most cases. Some examples of cosmetic surgery procedures include breast augmentation, liposuction, and facelifts.

There are some situations where cosmetic surgery may be deemed medically necessary, such as in cases of reconstructive surgery after a mastectomy or other disfiguring injury. In these cases, insurance may cover the cost of the procedure.

It’s important to note that insurance policies vary widely and some may cover certain cosmetic procedures if they are deemed medically necessary. However, in general, patients should not expect their insurance to cover the cost of elective cosmetic surgery procedure.

What is a medically necessary reason for having a tummy tuck?

While tummy tucks are primarily performed for cosmetic reasons, there are some situations where the procedure may be deemed a medical necessity.

Some examples of medically necessary reasons for having a tummy tuck include:

• Correcting muscle separation: Pregnancy, weight gain, and aging can cause the muscles in the abdominal wall to separate, resulting in a condition called diastasis recti. This can cause back pain, poor posture, and digestive issues. A tummy tuck can repair this separation by tightening the abdominal muscles.
• Removing excess skin after weight loss: After significant weight loss, the skin in the abdominal area may be stretched out and loose. This can cause skin irritation, infections, and difficulty finding clothing that fits properly. A tummy tuck can remove the excess skin and improve the patient’s quality of life.
• Treating hernias: Some patients may develop hernias in the abdominal area that require surgical repair. A tummy tuck can be performed at the same time as hernia repair to improve the appearance of the abdominal area while addressing the medical issue.

It’s important to note that insurance coverage for tummy tucks is rare and usually only applies to cases where the procedure is deemed medically necessary. Each insurance policy is different, so patients should consult with their insurance provider to determine if their tummy tuck may be covered.

What to do if you can’t afford plastic surgery?

If you cannot afford plastic surgery, there are several options you may consider:

1. Save up for the procedure: If the procedure you want is not urgent, you may consider saving up for the surgery over time. You can create a budget and set aside money each month until you have saved enough to pay for the procedure.
2. Look for financing options: Many plastic surgeons offer financing options such as payment plans, credit cards, or loans to help patients pay for their procedures over time. You may also consider using a medical credit card or personal loan to cover the costs.
3. Research lower-cost alternatives: There may be alternative treatments or procedures that can achieve similar results at a lower cost. For example, non-surgical treatments such as Botox or dermal fillers can help reduce the signs of aging without the cost and recovery time associated with surgery.
4. Consider medical tourism: In some countries, plastic surgery procedures may be less expensive than in your home country. However, it’s important to thoroughly research the surgeon, facility, and safety regulations before considering medical tourism.
5. Consult with a non-profit organization: Some non-profit organizations offer assistance to individuals who need medical procedures but cannot afford them. You can research organizations that provide funding or low-cost options for plastic surgery procedures.

It’s important to remember that plastic surgery is a personal decision, and the most important factor is your health and safety.

If you cannot afford the procedure at this time, it may be best to postpone the surgery until you are able to pay for it or explore alternative options.

Contact Us to find out if Plastic Surgery procedures are covered by insurance?

If you think you may need plastic surgery that is medically necessary and are interested in learning more about whether or not your procedure may be covered by insurance, the first step is to be evaluated by one of our surgeons.

Call our convenient Portland office to schedule your consultation at Après Plastic Surgery today, and let us help you!