PLASTICS AND INSURANCE COVERAGE

A very important part of being an informed patient is understanding your insurance benefits. FIRST …Plastic surgery does not necessarily mean cosmetic surgery! Many carriers see “plastic surgery” and assume their insured is trying to have a cosmetic procedure performed at the insurance’s expense. Cosmetic surgery is performed to reshape normal structures of the body in order to improve appearance. Reconstructive surgery is performed on abnormal structures of the body generally to improve function and restore a normal appearance. It is unethical and fraudulent for a practice to represent any cosmetic procedure as reconstructive. Most practices contact your insurance for approval before proceeding with a case that could ultimately be at your own expense. Your insurance coverage depends on the policy you have with them and your specific situation. Each company has their own guidelines concerning medical necessity and what they consider cosmetic in nature.

Patients are able to appeal the insurance’s decision to deny coverage for their proposed surgery, if they and the surgeon feel strongly that it is medically necessary. The process is explained in your policy or benefits booklet. If your surgery is approved, the surgeon’s office will usually be able to determine any portion you will be responsible to pay yourself. Taking the necessary steps before surgery eliminates most surprises. For questions regarding insurance and surgery call our office.