Will Insurance Cover Cosmetic Surgery?

If you’ve ever considered enhancing your appearance through medical procedures, you’re in very good company. The American Society of Plastic Surgeons (ASPS) reported that nearly 18 million surgical and minimally-invasive cosmetic procedures were performed in 2018.

More and more people are availing themselves of these procedures. The 2018 statistic we shared above marked an increase of a quarter million procedures over 2017. The number of procedures performed has been steadily rising for the past five years.

According to the ASPS, the most popular procedures include:

Surgical procedures:

• Breast augmentation
• Liposuction
• Nose reshaping
• Eyelid surgery
• Tummy tuck

Minimally-invasive procedures:

• Botox
• Fillers
• Chemical peels
• Laser hair removal
• Microdermabrasion

Why the increase?

The uptick in these procedures has been attributed to a number of factors:

• Increased screen time that constantly exposes us to seemingly perfect-looking people
• Baby boomers seeking to look younger for their own satisfaction or because they are re-entering the dating scene
• Increased acceptance of cosmetic procedures, due in part to people “owning it” on social media
• Increased affordability of cosmetic procedures (due to more financing options and technology driving prices down)
• More options available. Whereas a facelift used to the main option for smoothing out wrinkles, Botox and fillers are cheaper, less-invasive options.

Will insurance cover?

If you’re considering these procedures, you’ve probably already looked into the cost, and you may be hoping that insurance can help defray that cost. Before we discuss insurance coverage, it’s important to define a couple of terms.

• Reconstructive procedures. These procedures can be performed to adjust a body part that may have been compromised by an injury, surgical procedure, infection, tumor, disease, or a congenital defect. They can also be done to improve a scar or a skin condition. These physical conditions often affect the daily lives, relationships, and self-esteem of the affected person. The purpose of these procedures is to restore a normal appearance or to improve the function of the body part in question.

• Elective cosmetic procedures. Generally considered to be for aesthetics only, these procedures adjust body features in order to improve physical imperfections and enhance appearance.

While most insurance companies will not cover procedures for cosmetic purposes only, they may be willing to cover them if they are reconstructive in nature and “medically necessary.” The challenge here is that different plans define “medically necessary” differently. Here are some considerations your insurance company may use to evaluate your case:

• Is it the result of a birth defect?
  Many insurance providers will restore people to normal appearance if they were born with an abnormal feature. For example, if someone is born with unusually sized, shaped or placed ears, their insurance may cover ear surgery known as otoplasty—even if the condition is not affecting hearing or any other ear function. It’s important to note, however, that insurance companies will be more likely to pay if you are young. If you wait until you are older, the insurance company may contend that since you have successfully dealt with the problem this long, you are equipped to deal with it for life.

• Does it impede function?
  An insurance company may be willing to relieve you of a condition that is keeping you from functioning properly in everyday life. For example, if you want an eyelid lift to make you look younger, you may not be able to get coverage. However, your insurance company may pay for an eyelid lift in the case of hooded eyelids that obstruct vision. Sometimes this consideration can result in a partial-payment scenario. For instance, if you need a nose job for medical reasons (such as chronic congestion resulting from a deviated septum) but also want the doctor to enhance the shape of your nose in the course of the surgery, your insurance provider may be willing to pay for the non-cosmetic aspects of the procedure.

• Does it cause pain or discomfort?
  Insurance companies may be willing to pay for a procedure if you can show that it relieves you of pain. A covered breast reduction is a common example of insurance companies paying for a procedure that allows a patient to be free of back pain and strain. Another example is sclerotherapy to treat varicose veins that cause a patient ongoing discomfort in their legs.

• Does it significantly affect mental health and wellness?
  If a doctor can prove that an abnormal feature is having a big effect on your mental state, insurance may be willing to cover it. For example, a teenager with abnormally large breasts (which can include young men with enlarged breasts), may be able to get a reduction to free them of the anxiety and embarrassment they may be feeling on account of their chest.

• Is it related to illness or prior surgeries?
  Federal law requires most insurance companies to cover reconstructive breast surgery after a mastectomy/lumpectomy. If this surgery results in abnormalities, many insurances will cover repairs. Also, doctors may use fat from the stomach or butt to reconstruct the breast(s). In these cases, insurance may cover a tummy tuck or butt lift as part of the breast reconstruction.

Our best advice here is that it doesn’t hurt to ask for coverage. If you are considering a cosmetic procedure, talk to your insurance provider to see what conditions might enable coverage. Then, talk with your doctor to see if you meet any of these conditions.

Your careful documentation may be able to help your case. If you believe a certain procedure is medically necessary for you, start logging your symptoms, to include their general nature, severity, and frequency. For example, if you have large breasts that are causing you pain, keep a log of how frequently you are experiencing back pain, the location of the pain, and the strength of the pain on a 1-10 scale.

If you can’t get insurance coverage, keep in mind that there are a number of ways to pay for non-covered cosmetic surgeries and other procedures.

• Medical credit cards. These cards can only be used for medical purposes. They are very easy to qualify for and often come with low-interest introductory offers. Many people use these cards to cover plastic surgery. Just make sure to read the fine print, which may require you to pay interest retroactively on the entire balance if you don’t make a payment deadline.

• Physician payment plans. Some doctors will offer in-house financing. Many of these plans are low-interest (or interest-free). Because they are offered on a small scale, they are not usually reported to the major credit bureaus, so they may not immediately affect your credit score if you miss a payment deadline. Just remember, though, that you will burn a bridge with your doctor if you fall behind on payments, which can put you in an uncomfortable position if you need something from him or her later.

• Credit cards. If you have (or can get) a card with 0% APR, you won’t have to pay any interest for a certain amount of time. In addition, if you have a rewards card, you may be able to get cashback or rewards points for your purchase. Just make sure that you can pay off your procedures within the 0% interest-timeframe as interest rates could jump up dramatically after that point. Failure to make payments could hurt your credit score.

While financing can be a helpful short-term option for making cosmetic procedures more affordable, make sure that you’ll be able to pay off your debts without becoming saddled by heavy interest payments. No matter how good it may feel to enhance your appearance, it won’t be worth the stress of wrecking your finances in the process.