Cosmetic Procedures and Insurance

Last Updated: January 28, 2013

Although many people enthusiastically embrace the idea of plastic surgery, their plans are often drawn up short by the cost involved. Consider the average price of the top 10 cosmetic surgeries of 2011 by surgeon's fees only:

  • Breast augmentation - $3,388
  • Nose job (Rhinoplasty) - $4,422
  • Eyelid surgery (Blepharoplasty) - $2,741
  • Liposuction - $2,859
  • Tummy tuck (Abdominoplasty) - $5,279
  • Face lift (Rhytidectomy) - $6,429
  • Breast lift (Mastopexy) - $4,286
  • Dermabrasion - $1,218
  • Forehead lift - $3,309
  • Breast implant removal, $2,292

Remember, these prices reflect surgeon's fees only, and do not include other potential charges such as; facility fees, anesthesia, medication, or any other ancillary expenses. Always get a complete cost breakdown before proceeding!

Although there are cases where these costs can be covered at least in part by health insurance, the policy holder almost always has some degree of a fight on their hands.

Reconstructive Surgeries and Insurance Benefits

If a procedure is considered to be a reconstruction, for instance a breast reconstruction after a mastectomy, an insurer is required by law to cover the surgery. In some cases these benefits also extend to breast reductions when the weight of large breasts contributes to poor posture and chronic back, neck, and shoulder pain.

For the most part, there are no issues when claims relate to cosmetic procedures to repair damages sustained in an accident or as a consequence of an act of violence. The same is true for surgeries to address birth defects, for instance the multiple operations that are often required to fix a cleft palate.

Conditions That Often Result in Partial Benefits

Less dramatic conditions can also lead to partial benefits for corrective procedures, for example the lifting of a drooping eyelid that is obscuring some degree of the patient's visual field. Fixing a deviated septum, which affects natural breathing, is often part of a nose job. The cosmetic aspect of that procedure would not be covered by insurance, but the corrective potion would. Needless to say the math is often difficult to work out, but given the great expense of the surgery, taking the time to do so is worth it.

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If a procedure is considered to be a reconstruction, for instance a breast reconstruction after a mastectomy, an insurer is required by law to cover the surgery.

All Health Insurance Varies

Every health plan and policy is different as are the circumstances of individual cases. The best strategy is to get as much information as possible from the surgeon in advance of the procedure, including a cost estimate, and then discuss the operation with your insurance company. Get anything they say about approving benefits in writing, and make sure you understand the relevant policy language.

The general "go by" statements in regard to cosmetic procedures and insurance are, however simple:

  • If the operation is just to enhance your appearance, and is thus a matter of vanity, insurance won't cover it.
  • If the surgery is reconstructive and will enhance your body's functional health and the quality of your life, insurance benefits will likely apply.

Also, do not lose sight of the fact that you will be responsible for the deductible on your health policy and any special co-pays. Take all of these into consideration as you contemplate the total cost of any cosmetic procedure.

If you are interested in having a cosmetic or plastic surgery procedure and are curious to see if your insurance will cover any part of it. Please contact your insurer or call the toll free number at the top of this page and one of our experts will be happy to help you. You may also fill out the form below and we will reach out to you.

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