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How To Get Insurance To Pay For Plastic Surgery

Find Out If You Are Eligible For Any Discounts Or Promotions

Using Insurance for Plastic Surgery!

Once youve narrowed down your top plastic surgeons, then you can ask them if theyre offering any discounts or promos. Some plastic surgeons offer discounts based on the payment scheme you have chosen.

At least youre already assured of the quality of the surgeons, right?

When saving for your plastic surgery, take your time before making any decision and look at all options to get the body you desire.

Step : Consult With / Interview Surgeon

I had a long list of questions when I went in for my surgery consultation. These questions assisted me in better understanding the procedure and getting to know the applicants I was interviewing.

This is a big medical treatment, and I needed a surgeon who could not only do the surgery correctly but also communicate well with me about my worries during the preparation and recovery process.

Questions to Ask Potential Diastasis Recti Surgeons

  • What method do you use to execute the surgery? Please elaborate on your technique.
  • Make an incision in the following ways and places:
  • Whats the best way to make a new belly button?
  • Do you mend with permanent or dissolvable sutures?
  • Do you suture your own wounds?
  • What types of sutures do you employ? Do you have any experience with running stitches?
  • How long will the procedure take?
  • Do you work with mesh? Note: Do your own study, although mesh has caused severe autoimmune reactions in some people. My surgeon was able to fix my diastasis without the need for surgery.
  • Do you use drains? Drains arent fun, but I recommend them.
  • How do you minimize the appearance of scars?
  • How many layers of closure do you use?
  • Where would you perform the surgery?
  • What is the recovery time? How long will the surgery be?

What Is Functional Eyelid Surgery

To improve ones facial look, eyelid surgery is a standard procedure. The surgery reduces the appearance of aging by removing extra skin and fat from the upper eyelids. Puffy bags under the eyes can be reduced or eliminated with eyelid surgery by removing excess skin and tissue from the lower eyelids. Eyelid surgery conducted exclusively for aesthetic purposes is not covered by health insurance because it is deemed elective.

If eyelid surgery is deemed medically essential, it may be reimbursed by health insurance. The thick skin that hangs over the lash line and obstructs the line of sight is removed during functional eyelid surgery. Daily activities like driving, reading, and texting might be complicated if your vision is hampered by extra skin on your upper eyelids that hangs down.

In order to discover whether or not eyelid surgery is covered by your insurance, youll typically need to provide documentation such as a vision test. A board-certified eye doctor, such as an oculoplastic surgeon, must conduct the vision test. Patients who have vision problems will have their condition documented by the surgeon and sent to their insurance company for review. Depending on the patients unique insurance plan, the insurance company may cover all or part of the cost of eyelid surgery.

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What Makes A Procedure ‘medically Necessary’

In June 1989, the American Medical Association adopted the following definitions of cosmetic surgery and reconstructive surgery that are used by health insurance companies to determine coverage.

  • Cosmetic Surgery: Performed to reshape normal structures of the body in order to improve the patients appearance and self-esteem.
  • Reconstructive Surgery: Performed on abnormal structures of the body, caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease.

In theory, the definitions are black and white: cosmetic procedures are not medically necessary plastic and reconstructive surgery procedures are. In reality, there is quite a bit of gray area. Many procedures have a dual purpose that treats both an aesthetic concern and a functional health problem. If the provider can document the medically necessary component of the procedure and any non-surgical remediation that was previously taken to correct the health issue, Medicare or private insurance may very well cover the cost.

Tips For Getting Covered

How you can easily get cosmetic surgery financing

If you think you may be a candidate for insurance-funded cosmetic plastic surgery, a good surgery center will work with your medical insurance to help you make a solid case.

Make it clear to your doctor and the insurance company that you have tried other measures such as weight loss, physical therapy, and pain treatment options before resorting to surgery. This will help your insurance provider see the surgery as a last resort, which will make them more likely to cover it.

Medical documentation is also a very important part of the process. Make sure you keep records stating every health change youve made as well as all the times you visited your doctor in search of a solution.

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Can My Cosmetic Surgery Be Covered By Insurance

The answer to this question is not necessarily black and white. Whether or not a procedure is covered by insurance depends heavily on several factors. Oftentimes, the deciding factor is whether the insurance company considers the procedure to be medically necessary. Purely cosmetic procedures, therefore, are not covered. For example, a patient who desires a facelift to address cosmetic signs of aging would not be eligible to have insurance cover the procedure.

There are some cases, however, when even cosmetic surgeries may be deemed necessary for health or functionality. For instance, many people suffer from impaired vision as a result of excess eyelid skin that droops into their field of vision. In this scenario, a blepharoplasty or eyelid lift may be partially covered by an insurance company. Another surgery that can sometimes be shown to be medically necessary is a panniculectomy, or excision of the excess skin on the lower abdomen . For some after weight loss patients, this hanging skin severely impairs their mobility and even causes chronic skin rashes, irritation, and infections.

Can I Buy Insurance To Cover Bariatric Surgery

Bariatric surgery can be covered by both private commercial and government-sponsored insurance programs, says Dr. Garber. However, there are no special types of insurance that will cover this type of procedure. If you intend to undergo weight loss surgery, but your current policy does not cover it, you have the option to enroll in a new policy during open enrollment that does provide coverage for bariatric surgery.

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Insurance Plans Accepted By Restore Plastic Surgery

There are a handful of procedures that qualify for insurance coverage, including breast reconstruction, breast reduction, and in some cases, eyelid surgery. Your health insurance protects you from bearing the full cost of these procedures. However, nearly all insurance plans come with cost-sharingyour provider pays a portion, and you pay the remainder. That amount relies on whether your plastic surgeon is in-network or out-of-network, which can be more difficult to discern than you may think.

While your doctor may be in-network, the lab that does your testing, the hospital, or pharmacy you use may fall out-of-network. For those reasons and many more, its crucial to understand your insurance plan and determine a range of what youll pay.

Restore Plastic Surgery accepts the following insurance plans, but if you dont see yours listed, give us a call to learn more:

  • Cigna Care Designated
  • Coventry/First Health/Assurant Health/Coventry National Network, GEHA, PCIP, Mail Handlers, Southcare, CNN, Primary Physicancare
  • Heritage Summit Workers Compensation
  • Humana Choice PPO
  • Humana Gold Choice
  • Humana Gold Plus
  • MDI Healthcare Solutions-Medical Partners of America/ Meritain Health
  • Multiplan/PHCS/Beech Street/Savility, MPI, Value Point
  • PrimeComp Workers Compensation
  • Tricare Prime and Standard WPS
  • UnitedHealthcare
  • AARP MedicareComplete issue through UnitedHealthcare
  • UnitedHealthcare Group Medicare Advantage

How Much Does A Mommy Makeover Cost

Will Insurance Cover Your Tummy Tuck? Tips from a Certified Plastic Surgery Medical Coder

Due to the highly personalized nature of each mommy makeover surgery, the cost of the procedure will vary from patient to patient. Fortunately, it is often more cost-effective to undergo a mommy makeover which combines multiple procedures in a single surgical setting rather than having individual procedures performed separately, which can also add to your recovery time. Once you have had your consultation with Dr. Rao and determined a course of action, the knowledgeable staff at Rao Plastic & Hand Surgery will provide you with an estimate for your surgery and any associated fees so that you can make financial decisions and prepare accordingly.

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Other Procedures Sometimes Covered By Insurance

Other procedures available at our San Francisco plastic surgery practice that are sometimes covered by insurance include:

  • Rhinoplasty: When performed to correct breathing problems or physical defects, rhinoplasty may be covered by insurance.
  • Facial plastic surgery: Surgery to correct disfigurement of facial features due to injury or disease may be covered by insurance.
  • Eyelid surgery: As stated above, there may be medical reasons for having to undergo eyelid surgery, in which case the procedure may be covered by insurance.
  • Any surgery performed to correct physical abnormalities or birth defects

To learn more about any of the procedures we offer at our San Francisco plastic surgery practice, please today. For answers to questions regarding your insurance coverage, we urge you to contact your insurance provider.

Does Health Insurance Cover Cosmetic Surgery

Updated on Thursday, June 24 2021 | 0 min. read by Bryan Ochalla and co-authored by Nick VinZant

Millions of Americans go under the knife every year to enhance their appearance in one way or another. Does health insurance cover those procedures?

Will your health insurance plan help you pay for that nose job youve always wanted?

Or will it cover an eyelid lift, breast augmentation, tummy tuck, or butt lift?

The answer to these questions depends mostly on what kind of insurance policy. Most cosmetic surgery, however, isnt covered by insurance. There are exceptions:

  • If the goal of the surgery is to enhance or improve your appearance, dont expect your insurance plan to pay for it.
  • If its aim is to repair a congenital defect or reconstruct a body part damaged by a burn, disease, or some sort of trauma, your policy may help out.

Thats just the gist, though. Keep reading to learn more about:

  • How various types of health plans treat cosmetic and plastic surgery.
  • Common exceptions
  • How to find out if your health insurance will or wont cover a procedure.
  • Your options if your insurance policy wont the procedure you need or want to have done.
  • How much you might pay for plastic or cosmetic surgery .

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Free Plastic Surgery Procedures

You can score almost free plastic surgery by getting your insurance to cover the procedure . If successful, your plan would pay the majority of expenses, leaving you to fund only the deductible, coinsurance, and copayments if applicable.

Consider these examples that illustrate the fine line between plastic versus cosmetic designations.

Financial assistance for surgery without insurance is far more limited.

Excess Skin Removal

Patients might be able to score almost free excess skin removal surgery in 2022 after dramatic weight loss. Your insurance could pay most of your Panniculectomy expenses when you can show that the extra epidermis affects your health.

You do not need to find plastic surgeons who perform pro bono excess skin removal when a third party has a contractual obligation to cover the expense: when it is medically necessary.

Nose Job

A similar strategy answers how patients can get a primarily free nose job. Your insurance could pay most of your expenses when you can show that a crooked proboscis affects your health.

You do not need to find pro bono plastic surgeons that perform nose jobs when a third party has a contractual obligation to honor claims: when it is medically necessary.

  • Persistent dermatitis
  • How Do I Know If I Have Enough Documentation

    How To Get Insurance To Pay For Eyelid Surgery

    Chances are that youve already talked to your primary care doctor about your various symptoms. Your general practitioner or internist probably referred you to specialists to try to relieve your pain and discomfort. If you havent been treated specifically for a condition related to the size of your breasts, ask your primary care doctor to make a referral so you can get the reports you need for your breast reduction insurance.

    At Rowe Plastic Surgery, the staff is fluent when it comes to insurance-speak. They can point you in the right direction to get covered for breast reduction surgery. Theyll even help you fill out the required paperwork. Some of the treatments that help you qualify for insurance for breast reduction include:

    • Chiropractic adjustments
    • Prescriptions for a proper bra fitting
    • A weight loss program
    • Pain medications

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    How To Get Bariatric Surgery Covered By Insurance

    In certain situations, your health insurance may cover the cost of bariatric surgery. In addition, some states are required to cover bariatric surgery if you have an ACA-compliant health insurance plan through the Marketplace.

    However, weight loss surgery is not automatically covered by every policy, and for every person. If you want to get your health insurance provider to cover weight loss surgery, heres what you need to do:

  • Check the details of your health insurance policy: The first step is to review your policy details to see if bariatric surgery is a covered procedure. You also can contact your insurance company and speak with an agent, who can walk you through the fine print of your policy and whats covered.
  • Find a surgeon that is in your network: Next, youll want to choose a surgeon who is in your health plan network. Depending on your plan, a portion of the cost may be paid for if you visit an out-of-network provider. However, because bariatric surgery can be very expensive, seeing an in-network doctor will likely reduce your out-of-pocket cost significantly.
  • Possible Partial Coverage For Plastic Surgery Procedures

    There also may be partial coverage available for any portion of an operation that is not considered cosmetic. A perfect example of this is the correction of a deviated septum within a rhinoplasty procedure.

    Since a deviated septum can negatively affect a patient’s breathing and contribute to an increased incidence of infection, the correction would likely be covered. However, the part of the surgery designed to correct cosmetic aspects of the nose’s appearance would not be covered.

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    How Can I Get My Plastic Surgery Covered By Insurance

    In the end, whether or not your surgery is covered by insurance is in the hands of your insurance provider. There are a few things you can do, though, to give yourself the best possible chance of being considered for coverage and proving that your surgery is medically necessary, including:

    • Document your condition with photographs and logs.
    • Keep detailed records of every visit to the doctor, hospital, or other facility that pertains to your condition. This includes any product purchases or therapies.
    • Be able to show that you have exhausted all of your options to treat your condition and that surgery is the last resort.
    • Obtain statements from your doctor and other medical professionals recommending that your desired surgery be performed for medical/functional reasons.
    • Select a qualified, certified, and reputable surgeon and treatment facility.

    The caring team at Après Plastic Surgery knows how frustrating it can be to suffer from a real condition but be unable to get coverage for treatment. If you think you may need plastic surgery that is medically necessary and are interested in learning more about whether or not your procedure may be covered by insurance, the first step is to be evaluated by one of our surgeons. Call our convenient Portland office to schedule your consultation at Après Plastic Surgery today, and let us help you!

    How Much Do Plastic Surgery Procedures Cost


    Cosmetic surgery gets more popular every year. In 2018, more than 17.7 million procedures were done in the U.S. alone. The American Society of Plastic Surgeons reports that Americans spent more than $16 billion on cosmetic operations that year. Considering the amount of money involved, its no wonder people are on the lookout for plastic surgery financing.

    These are the average prices for the most popular cosmetic surgeries and non-surgical cosmetic procedures:

    Average Cost of Top 5 cosmetic surgery procedures in 2018

    • Breast Augmentation $3,515

    American Society for Aesthetic Plastic Surgery.

    While the non-surgical options may seem affordable, these cost estimates can be deceptive. Thats because many of these procedures require multiple sessions to achieve results.

    Are you wondering if health insurance covers cosmetic surgery? Is your health insurance an alternative to plastic surgery financing? The answer is maybe. Read on to learn more.

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    What Kinds Of Plastic Surgery Procedures Are Covered By Insurance

    Most forms of plastic surgery are elective procedures, which means they arent typically covered by health insurance. In some cases, certain procedures may be partially or fully covered. Whether or not your surgery is eligible for insurance depends on the procedure youre having and the reason youre having it. It may also depend on who your insurance provider is.

    In most cases, for insurance to pay for plastic surgery, the procedure must be either:

    • Reconstructive, or
    • Essential to preserving or improving your quality of life or bodily function

    It cant be a procedure thats performed purely for cosmetic reasons.

    For instance, insurance doesnt cover the cost of breast implants for a woman who wants to increase her breast size. However, for a woman who has had a mastectomy to remove breast cancer, insurance will cover the cost of any breast reconstruction surgery she needs to replace the lost breast.

    Some other instances where plastic surgery might be covered by insurance include:

    Abdominal surgery : If performed to remove excess skin that causes health problems such as back pain, rashes, or skin irritation

    Breast surgery: If performed to reduce breast size or correct asymmetry thats causing back problems or other health issues, or a breast reduction for men with gynecomastia

    Blepharoplasty : If eyelid drooping causes vision problems


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