You’ve probably heard it time and time again that some cosmetic procedures are covered by insurance. Yes, it’s true that a handful of treatments may cost you less in the long run if you are able to run the surgery through your insurance company, but you really need to know the ins and outs of doing this and what qualifies for coverage and/or reimbursement.
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“Insurance companies are not as forgiving as they were 10 to 15 years ago. There were times that insurance would only require a letter from the surgeon requesting approval with minimal documentation,” says Torrance, CA, plastic surgeon Linda Swanson, MD. “Now, it seems that a patient needs to have a minimum of three to four months of conservative treatment for the problem to try and cure it either by a surgeon or another physician. This proof needs to be sent to the insurance company with the initial request.” Sometimes, it can take up to 45 days to hear back from the insurance company as to whether they will cover the cost of the procedure or not.
We asked five doctors to help us hash out this somewhat sticky situation.
The replacement of fillings may be covered.
Beverly Hills, CA, cosmetic dentist Kourosh Maddahi, DDS, says insurance does not typically cover aesthetic dental procedures. “However, if you have a damaged silver filling that is replaced, insurance may pay for the cost.” If you choose to go with a white, porcelain filling instead, you may have to pay out of pocket for any costs associated with the procedure. “When it comes to crowns and veneers, if there is a large enough of a fracture or decay, insurance will pay for a crown or a veneer with photos, X-rays and an accurate explanation. Bonding on the front teeth is the easiest procedure to get insurance coverage on because it is less expensive than crowns or veneers and a silver filling can not be use on the front teeth, but, there has to be a chip, or decay in order for the expense to be covered.”
Breast reductions are often included.
If you’re seeking out a breast reduction due to back problems, New York plastic surgeon Roman Rayham, MD, says the procedure would be covered by insurance.
Breast reconstruction is usually covered.
According to Dr. Swanson, your insurance policy (depending on the coverage you have) may pick up the cost of breast reconstruction post-mastectomy. “I recommend that if a patient is thinking of using their insurance for a procedure like this, that they get to know their insurance policy and call the company for further information.” She adds that possibly any reconstructive procedure for post-extreme weight loss, like an abdominoplasty, is up for potential coverage, too.
Upper eyelid surgery can be billed to your insurance company.
When the upper eyelids get in the way of a patient’s vision, the cost of correction via surgery may be covered. “Technically, only the ptosis repair is performed, but that may have a cosmetic improvement as well,” says Louisville, KY, plastic surgeon Nana Mizuguchi, MD.
Botox for some noncosmetic-related procedures may be picked up by insurance.
Orlando, FL, plastic surgeon Armando Soto, MD, says that some injectables, like Botox Cosmetic, get approved for the treatment of migraines and other spasticity syndromes. “However, these are not cosmetic procedures.” So, don’t expect for your insurance company to pay for Botox to fight off wrinkles.
