Reconstructive versus Cosmetic Surgery
It would be nice if health insurance policies covered all plastic surgery, but in the real world, most insurance companies follow the lead of both the American Medical Association and the American Society of Plastic Surgeons, and make a clear distinction between two types of plastic surgery: reconstructive and cosmetic. Reconstructive surgery is plastic surgery that is covered by most health insurance companies and there are very clear guidelines when it comes to defining such surgery.
Reconstructive surgery is surgery performed on abnormal structures that may be caused by congenital defects, developmental abnormalities, disease, infection, trauma, or tumors. Here's a breakdown on the various types of reconstructive surgery:
Abdominal Surgery-If surgery will improve or eliminate such health problems as back pain, hernia, inability to walk in normal fashion, rashes, and sores.
Breast Surgery-If surgery corrects asymmetry or large male breasts, reduces large breasts that cause health problems, is reconstructive due to loss, or corrects a congenital absence.
Ear Surgery-If surgery will correct ears deformed by birth, disease, or injury.
Eyelid Surgery-If surgery will correct droopy eyelids that affect vision or eyelids that are turned in an abnormal manner.
Facial Surgery-If surgery will balance an appearance marked by paralysis, or to treat deformities in the facial muscles, head, or neck.
Hand Surgery-If surgery will treat carpal tunnel syndrome, Dupuytren's contracture, fused fingers, nerve or tendon injuries, and other deformities.
Nasal Surgery-If surgery will correct deformities that arise from birth and disease, or that interfere with the ability to breathe.
Cosmetic surgery reshapes normal structures on the body to improve the appearance or self-esteem of the patient. Such procedures would include many physical improvements that are not medical necessities, such as nose jobs, breast implants, laser hair removal, hair transplants, and the elimination of spider veins. This is just a short list of the types of cosmetic surgeries that are not liable for coverage by your insurance carrier.
It makes sense to take the time to read your health insurance plan booklet since that's the place you'll find quick answers to your questions about which surgeries are covered by your plan. You'll also find information about the appeals process and what you can expect in the way of deductible expenses for a given procedure.
All health insurance companies have a list of what they consider to be pre-approved medical procedures. A simple phone call to your provider should save you a great deal of time when you need to find out if the procedure you need or would like to have is covered. Make sure to ask about exceptions, any recent changes to the rules, or special considerations that may apply. Have the company mail or fax you the approval letter or the relevant document outlining the exact coverage details for the procedure in question.