If you’re like most people, cost is one of the factors you consider when deciding whether to have surgery or some type of cosmetic enhancement procedure. Will your health insurance help pay?
Each insurance company has its own set of policies regarding what is or isn’t covered. And, of course, individual coverage can vary widely, too. If you have non-traditional insurance such as a health savings account (HSA) or flexible spending account, that may also affect your coverage options.
Plastic surgery and cosmetic surgery are not the same
Cosmetic surgeons perform only procedures that involve soft tissues and aim to change the visual appearance of some part of the body. Plastic surgeons also perform reconstructive surgical procedures that involve structural components such as cartilage and bone. For example, Dr. Raval is a board-certified plastic surgeon who specializes in rhinoplasty – surgery that usually requires altering the nose’s physical structure in order to achieve desired aesthetic or functional results.
Even so, it is your insurance carrier and their plan, not the type of surgeon, who determines whether your medical insurance will cover the cost of your procedure.
Medical insurance is just that – medical. You might want to “look better” in some way, but that’s strictly an elective decision on your part. It’s about your self-image, not your basic health and welfare. So coverage rarely extends to procedures the insurance carrier considers cosmetic. That includes treatments to reduce signs of aging and resurface the skin.
For example, your insurance may cover the cost of treating acne while it is active, but not the cost of reducing the appearance of acne scarring later on. And since non- or minimally-invasive cosmetic procedures such as Botox or laser are not medically necessary, they probably won’t be covered. During your consultation, our staff will provide you with an estimate for cosmetic procedure costs which are probably not covered by insurance.
Rhinoplasty is often medical
Nose surgery can address two very different issues – changing the visual appearance of your nose or changing the physical functionality of your nose. Altering the size or shape of your nose to give it a new look is a purely cosmetic decision, one that is not covered by medical insurance.
However, difficulty breathing is a medical problem, one that can disrupt your sleep and your ability to function well during the day. Insurance companies recognize that, and usually cover the cost of nasal valve surgery to correct problems caused by genetic defects, illness, accidents or other injuries.
Often, structural issues that cause breathing problems also cause your nose to look crooked or otherwise misshapen. Therefore, many men and women choose a dual rhinoplasty – surgery that corrects the internal structure of the nose to restore breathing and also modifies external appearance. In these cases, health insurance typically will cover the portion of expenses associated with nasal valve repair. So you can get at least some financial help.
Sometimes there are gray areas. For instance, what if your face is damaged in an auto accident? You could very well need both aesthetic and structural repairs, but your insurance company may determine that the entire procedure is covered because it is necessary to resume your previous quality of life.
The bottom line
Never assume your medical insurance will cover something, but never assume it will not, either. Either way, you might be surprised, and you certainly don’t want to be surprised after the fact. So, read the coverage documents that explain the details of your personal coverage, but also call your insurance carrier and ask specifically about the surgical or other procedure(s) you are considering. Remember to inquire if the plan considers the doctor as in-network or out of-network which could affect your out of pocket costs.
Once you know your deductible and co-insurance benefits, we can provide a rough estimate of the fees for Dr. Raval. You should also check with the surgery center and anesthesiologists to get their fee estimates and ask about related expenses such as post-procedure medications and supplies.
Remember you will still have to meet your deductible and any co-insurance, even if the insurer does cover some of the cost. Whatever they say, be sure to get it in writing.
To learn more about a Rhinoplasty procedure and the costs, download our Rhinoplasty Q&A eBook.