What Cosmetic Surgery Procedures Are Covered By Insurance?

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As with most of the things we buy or do in life, cost is a factor. The same goes for plastic surgery. If you are considering having a cosmetic procedure performed, it is only natural to wonder what financial obligations you will have and whether or not a portion of the procedure could be covered by insurance. The knowledgeable team at Après Plastic Surgery in Portland, OR is dedicated to providing the most exceptional level of care, including helping decipher the sometimes confusing world of insurance coverage as it applies to cosmetic surgery.

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 (pannus). For some after weight loss patients, this hanging skin severely impairs their mobility and even causes chronic skin rashes, irritation, and infections.

Which cosmetic surgeries are usually covered by insurance? 

It is difficult to say that a specific procedure is “often” covered by insurance because coverage details and decisions can vary greatly from case to case. Again, the determining factor of whether or not a procedure is covered by insurance typically comes down to the reason the surgery is being performed. Some of the most common cosmetic procedures that have justifiable benefits for insurance coverage consideration include:

  • Rhinoplasty: in the case of problems breathing or sleeping
  • Blepharoplasty: in the case of impaired vision
  • Breast implant removal: in the case of breast implant-associated illness 
  • Skin removal surgery: in the case of chronic rash, infection, or other condition
  • Breast augmentation or reconstruction: in the case of mastectomy for breast cancer

Can my nose job be covered by insurance?

Rhinoplasty, commonly known as a nose job, is an interesting case where oftentimes patients have the procedure performed primarily for medical/functional reasons but receive the cosmetic benefits of the surgery secondarily. A large number of men and women undergo rhinoplasty to address a deviated septum, small nostrils, or other mechanical flaw, which obstructs nasal airflow and can lead to trouble breathing, difficulty sleeping, and even sleep apnea. In many of these cases, rhinoplasty will be considered a necessary procedure and, in turn, be covered by the patient’s insurer. As a result of the manipulation necessary during rhinoplasty, the patient may also achieve a more appealing nasal contour, even though the procedure was not intended as a cosmetic one. 

During your initial consultation at Après Plastic Surgery, one of our exceptional board-certified plastic surgeons will thoroughly evaluate your situation, discuss your goals and concerns, and give you a realistic idea of what results are possible with your intended procedure and if there is an opportunity to receive any insurance benefits. 

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! 

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.