Will My Insurance Cover Plastic Surgery?

Q: I am interested in having several plastic surgery procedures done. Do you know if I can use my health insurance for plastic surgery?

A: Your health insurance is intended to cover medically necessary procedures. From a plastic surgery standpoint, operations such as breast reduction, large abdominal panniculectomies, repair of cleft lip and palate deformities, traumatic facial injuries, removal and reconstruction of skin cancers, breast reconstruction after cancer removal, and numerous other face and body problems constitutes reconstructive plastic surgery. They are reconstructive because they are directed toward returning the body part back to what it once or should be (e.g., breast reconstruction) to relieving medical symptoms such as pain and skin rashes. (e.g., breast reduction) Cosmetic plastic surgery, conversely, changes a normal body part to have another look (e.g., breast augmentation) even though there are no medical symptoms with it. Not liking the way something looks and being bothered by it, even if that degree of bother borders on some level of impairment, does not constitute a medical necessity. Therefore, cosmetic surgery is not covered by any known medical insurance program in the world. There are a few instances where a body part can have both reconstructive and cosmetic needs. The nose would be a prime example where the internal breathing parts can be covered by insurance when they are dysfunctional (septoplasty), while changing the outside appearance of the nose (rhinoplasty) would be considered cosmetic. When done together which is common, such a procedure is known as a septorhinoplasty.

Dr. Barry Eppley

Indianapolis, Indiana