There can be some confusion when it comes to plastic surgery and health insurance. Many people assume that their health insurance provider will cover any procedure done by a licensed medical doctor. However, most health insurance coverage makes a distinction between medically-relevant and cosmetic procedures. This article will look at the difference between the two.
Procedures Covered by Insurance
The procedures commonly covered by health insurance are those that are seen as necessary for the health and well-being of a patient. These procedures may correct congenital issues. For example, balloon sinuplasty is a procedure that is normally covered by insurance. Balloon sinuplasty is a treatment for chronically blocked sinuses, permitting normal drainage by widening the sinuses without surgery. Without the procedure, a patient may experience frequent headaches and recurring sinus infections, making day to day life difficult. Reconstructive surgery after an injury will also frequently be covered by health insurance, allowing the patient to return to his or her regular lifestyle.
Procedures Not Typically Covered by Insurance
Procedures that are not typically covered by insurance tend to be cosmetic in nature. Plastic surgeons can do amazing work at changing the appearance of a patient, enhancing some parts while reducing the size of others. If the patient is simply trying to improve his or her appearance through elective surgery, the insurance provider will expect the patient to cover the cost. For example, procedures to remove the wrinkles that are a natural part of the aging process are not seen as medically necessary and will not be covered.
Health insurance is designed to help people deal with medical issues that affect their long-term well-being. Covering elective cosmetic surgeries would make health insurance too expensive, leaving a large portion of the population uninsured. There can be some debate about cosmetic surgeries that are medically necessary. For example, some surgical weight-loss procedures may become medically necessary if obesity is causing other issues for the patient. Breast reduction surgery may be covered if the patient is experiencing back pain due to breast size. These are the sorts of issues that health insurance providers regularly have to evaluate.
If you are considering plastic surgery and are uncertain of your provider’s coverage, your best bet is to contact your insurance provider directly. They may be able to give you an immediate answer or give you the tools you need to appeal your procedure as medically necessary. Insurance companies want to work with you so that you can live your healthiest life.
Make sure to see how Lazor Insurance can help you, your business, or your family so you can be protected for whatever may come in the future!