Cosmetic and Reconstructive Surgery - Will My Health Plan Provide Coverage?:

With millions of people flocking to have cosmetic and reconstructive procedures performed in the United States, it is helpful to understand what your insurance policy will and will not cover. If you have been thinking about getting either cosmetic or reconstructive surgery, it is a good idea to go over your current health policy to see if your procedure will be covered.

Most health insurance plans follow some general guidelines for cosmetic and reconstructive procedures, which we will outline below.

In general, health insurance companies make use of the definitions for cosmetic surgery and reconstructive surgery that are provided by the AMA or American Medical Association and the ASPS or American Society of Plastic Surgeons. These definitions clear up the grey areas, in most cases, surrounding these procedures.

The accepted definition for cosmetic surgery is a procedure that is performed to reshape, restructure or change the physical appearance of a patient to assist their self-esteem. In other words, this type of procedure is deemed not "medically necessary." If your life and overall quality of health are not affected by your desire to have this surgery, your insurance company will normally not provide coverage. Examples of cosmetic surgery include face-lifts, nose reconstructions, breast augmentation, tummy tucks, liposuction and other procedures that affect your appearance.

Reconstructive surgery is commonly defined as being "medically necessary," and is used to describe procedures that are performed to correct defects, abnormalities or trauma that is caused by an accident, sickness or disease.

A good example of reconstructive surgery would be the repair of a cleft palate or the reconstruction of someone's face after a horrible accident. These procedures are commonly covered by the majority of health insurance providers, although there may be some exceptions.

There are some procedures that your insurance company may cover that you may not think would be included. These procedures may include:

Breast Surgery: procedures performed to correct congenital abnormalities, such as size difference, breast reductions, or reconstruction due to loss, such as a mastectomy may be covered by your health insurance plan.

Nasal and Facial Surgery: procedures to correct eyelid problems, difficulties in breathing, ear deformities or injuries, or facial paralysis are typically covered by health insurance plans.

Hand Surgery: procedures to fix carpal tunnel or other injuries or diseases to the hands are now commonly covered by many health insurance companies.

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