Does insurance cover plastic surgery?

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If you would be thinking about plastic surgery, then it would not come as a surprise that you would be on the lookout for some discounts and price cuts. This is something that you would be able to get by looking at your medical insurance coverage.

In this case, you would be able to find good news to some extent. The cases which would be deemed medically necessary would definitely be approved and covered by your medical insurance. This would even include those surgeries which would enhance your physical appearance. For instance, breast reduction surgery which would be performed as a result of the removal of excess skin and treat your aching back would definitely be given the green signal.

In simpler terms, the main goal would be to make a strong and compelling argument regarding why your particular surgery would be necessary and how it would help to improve the quality of your life.

Definition of medically necessary surgeries
While you would be able to find varying opinions on this, the sad truth is that there would not be one correct answer. This is because different insurance companies seem to lay out different guidelines regarding the kinds of surgeries which would be deemed medically necessary. However, some common aspects would definitely have to be covered.

• Reconstructive surgery

This would be defined as the kind of surgery which would be performed on structures deemed to be abnormal. These would be caused by developmental abnormalities, congenital defects, infection, trauma, disease, or tumors. By undergoing surgery, it could help to give normal appearance of improve function.
• Cosmetic surgery

This would include reshaping of normal structures in order to improve physical appearance or self-esteem. For example, laser resurfacing could help to even out uneven complexion or butt lifts could help to improve the overall appearance of your backside.

• Impact on daily functioning and life

Some of the insurance providers would take in to account how a particular surgery would affect the daily life and activities of a patient. For instance, if someone would suffer from back pain as a result of large and sagging breasts, then breast reduction surgery would be deemed to be required for medical reasons. This is because this excess skin could get in the way of performing normal chores such as bending down or lifting something up.

 

Photo documentation
In order to make sure that your cosmetic surgery pro would be approved or covered by your medical insurance coverage, photo documents would need to be provided. This is because they would like to see that the situation is indeed as bad as the doctor claims it to be. As such, it would be important that you bring it along with you as evidence. This is because insurance companies seem to have become more restrictive in getting claims approved.

Conservative measures being failed
Another factor which insurance providers seem to take in to account is whether alternative options have been tried and exhausted or not. This would include the patient undergoing other procedures, prescribing medication, and even going for physical therapy. If all of these would be tried but to no avail, the plastic surgery would be the only option which would remain. The best case would be to show all evidences that everything has been tried but with no results.