Is Plastic Surgery Covered by Insurance? | Surgery Costs

Is Plastic Surgery Covered by Insurance?

The question of whether plastic surgery is covered by insurance depends on the details of your insurance policy. Generally, cosmetic plastic surgery is not covered by insurance, but medically necessary or reconstructive plastic surgery is more likely covered.

This can change depending on the policy. But most insurance companies will not choose to cover the costs of elective, cosmetic surgery. Knowing what plastic surgery is covered by insurance requires understanding the different types of plastic surgery available.

Who Pays for Plastic Surgery?

Whether insurance will pay for plastic surgery depends on which insurance company you use, the type of coverage you have and the exact type of procedure you want to get.

Most insurance companies divide plastic surgery into procedures that are cosmetic, reconstructive or medically essential to preserve body function or quality of life, according to The Balance.

Here are some different procedures by category where typically plastic surgery is covered by insurance.

Reconstructive Surgery

According to the American Society of Plastic Surgeons (ASPS), reconstructive surgery is “performed to treat structures of the body affected aesthetically or functionally by congenital defects, developmental abnormalities, trauma, infection, tumors or disease.”

Such procedures are done to improve the function and abilities of the patient, although it may also be done to “achieve a more typical appearance of the affected structure,” according to the ASPS.

  • Breast reconstruction
  • Cleft lip and palate repair
  • Congenital anomalies (birth defects that could include surgery to eyelids, ears and nose)
  • Facial surgery
  • Hand surgery
  • Abdominal surgery (for issues such as back pain, hernias, or to correct difficulty with walking)

Cosmetic surgery

Unfortunately, most cosmetic surgery is not covered by health insurance plans. This is despite the fact that the amount of plastic surgery has increased 538% for women and 325% for men since 1997, according to the American Society for Aesthetic Plastic Surgery.

Insurance can vary from company to company and policy to policy, so it’s important to know the details of what your policy says.

Examples of cosmetic procedures that are usually not covered include:

However, it’s important to note that some of these may be covered if they involve a situation where insurers consider the procedure to be medically necessary, such as a tummy tuck for someone who is morbidly obese and experiencing the lowered quality of life because of it, according to The Balance.

As with all things involving plastic surgery, it’s important to consult with a professional surgeon before considering any procedure. And in the case of determining who will pay, it’s important to consult your insurance policy.

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