Insurance Coverage and Plastic Surgery
While most procedures performed by plastic surgeons are cosmetic in nature and not covered by insurance, many others are considered medically necessary and are generally covered by third party payers.
Breast reduction is commonly covered by insurance companies as a medically necessary procedure for relief of neck, shoulder and back pain related to large, heavy breasts. Each company has its own criteria for coverage and is often determined by the height and weight of the patient as well as the weight of tissue that is to be removed. A breast lift is similar to a breast reduction except that little, if any, actual breast tissue is removed and is considered a cosmetic procedure. Patients who are denied by their insurance for a breast reduction can proceed for the procedure out of pocket as a cosmetic surgery.
Breast reconstruction is also typically covered by insurance when a breast is lost or becomes deformed due to breast cancer surgery. Some companies set a limit on how many procedures or revisions are allowed.
Patients who have lost a considerable amount of weight are often seen to have a tummy tuck to get rid of the hanging fold of skin on the lower abdomen. In these cases where the patient is suffering from a rash under the skin fold, insurance may cover a panniculectomy but not a tummy tuck. With the former, the apron of skin is removed without additional liposuction, muscle tightening or transposition of the belly button that is commonly performed at the time of an abdominoplasty.
An upper blepharoplasty can be covered by insurance to remove excess upper eyelid skin if it is severe enough to actually cause an obstruction to the vision. Prior authorization is necessary, as is required with all of the above procedures, and requires that a visual field test is done first to determine how much of the visual field is obstructed and how much it will improve with the procedure.
Contact Us to find out if Insurance Coverage is an option for you!