Many people regard cosmetic surgery as a symptom of vanity, even though our appearance can severely affect our emotional and mental well-being. So it seems like a pipe dream to hope that health insurance will cover these expensive operations. But it may actually be possible, with the right individual health insurance plans.
The basic principle is that you need surgery as part of the treatment plan for a medical problem you have. Your doctor will also have to attest to this fact.
Here are several possible cases in which this can work:
- Breast reduction. While augmentation may never qualify for coverage, in some instances the insurance company may cover reduction. You first have to visit your primary care doctor who can document that you have some shoulder, neck, or back pain brought on by your breasts. Your doctor will have to attest that your large breasts are the cause of the problem.
Once that’s established, you will have to try other treatments such as physical therapy first. Only when that doesn’t work can reduction be considered as part of your coverage.
There’s also a weight requirement that must be met before the procedure can be covered. The amount depends on your height and weight. This and other requirements must be met before this procedure is considered medically necessary.
- Nose jobs. Rhinoplasty isn’t covered by insurance because this only changes the appearance of your nose. However, there’s a nose job called a septoplasty, which is performed for patients with a deviated septum. Your doctor needs to confirm that this surgery is warranted such as if your breathing is disrupted.
So this means you can get septoplasty with the help of your insurance, and then a rhinoplasty on top of that at your own expense.
- Many dental insurance companies may help cover the cost of these “invisible” braces. However, they may only reimburse up to half of the cost. You may still have to shell out a lot of money for your share of the bill.
- Weight loss surgery. You may think this type of surgery would is covered, since obesity is associated with a long list of serious medical conditions. In fact, your insurance company will pay for gastric bypass surgery if you’re morbidly obese, except it’s not that simple.
First, you will need to go through a psych evaluation so that your doctors can be assured that you will maintain your reduced weight after the procedure. Then you will need to go through a year of supervised diet and exercise.
The weight loss surgery can be covered if it meets these and other requirements. However, you will have to cover the cost of getting rid of the excess skin. It’s considered a cosmetic problem and not a medical necessity.
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