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Health Insurance and Cosmetic and Reconstructive Surgery

What does health insurance cover in regards to cosmetic and reconstructive surgery? There are many differences between cosmetic and reconstructive surgeries, and those differences are necessary to understand in order for your health insurance carrier to make the decision to cover or not cover the surgery expenses.

According to the American Society for Aesthetic Plastic Surgery (ASAPS) there were about 11.5 million cosmetic non-surgical and surgical procedures in 2006 accounting for approximately 12.2 billion dollars. This number has been increasing regardless because the American people are not only trying to live better, but also look better. Before rushing to make a decision of whether or not to have cosmetic or reconstructive surgery, it’s important to know what your insurance carrier covers in concern to these operations.

Before looking at what is or isn’t covered by health insurance companies, let’s first see some of the average prices a person should expect to pay in the case of cosmetic surgery. A survey conducted in 2005 by the American Society of Plastic Surgeons rounded up some of the costs depending on the kind of procedure you would want done:

Botox $ 363
Cheek Implants $ 1,764
Eyelid Surgery $ 2,534
Face Lift $ 4,484
Forehead/Brow Lift $ 2,420
Nose Surgery $ 3,511

It is important to keep in mind that these prices were estimated in 2005, which means that a person must expect to pay more if they wanted the procedure done today. Also, you must add ancillary expenses like anesthesia and operating room facilities charges to arrive at a more accurate cost estimate.

Now that we know how much some of the cosmetic surgeries cost, lets look at the Health Care Industry and what they cover in concern to these medical operations. The reason for a person to have medical insurance is to protect themselves in case of an accident or illness that comes unexpectedly. For this reason almost all cosmetic surgeries aren’t covered by your insurance carrier.

However, reconstructive surgeries after an accident are covered by most insurance companies. Because of this, a lot of people have been asking their doctors to give them documentation sustaining their reasons for having cosmetic surgeries. This list developed from information given by The American Society of Plastic Surgeons shows procedures that might be covered by insurance companies:

1. Abdominal Surgery: Only when is performed to cure health problems such as hernias, back pains and sores. 2. Breast Surgery: Only when is cures breast asymmetry, reduce the size of breast that are causing back or neck pain and reconstruct a breast due to a disease. 3. Ear Surgery: Only when it’s performed to cure congenitally deformed ears or to reconstruct an ear or both ears in case of an injury. 4. Eyelid Surgery: Only if the eyelids are drooping and they are obstructing vision. 5. Facial Surgery: This is only covered to correct the face due to a facial paralysis or to treat facial deformities. 6. Nasal Surgery: Only to treat injuries or nasal deformities that may affect breathing or to correct deformities due to a disease.

With this information we can note that reconstructive surgery is definitely covered by health insurance, while only some cosmetic surgeries are. Nevertheless, people that want to have their cosmetic surgery paid by their health insurance can ask their doctors if there they have any condition that would help them achieve this, and those who don’t then would have to pay full price for the surgeries. For more information on what is covered in concern to cosmetic/reconstructive surgery, you can inquire of The American Society of Plastic Surgeons or speak with a licensed insurance agent that is familiar with the top insurance companies in your area.

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