Will Health Insurance Pay for Cosmetic Surgery?

Author:
Marcy Goodfleisch
Updated:
Aug 22, 2022

Check to see if the surgery or procedure you want is covered.
Divya MU via Wikimedia. CC BY 3.0

How to Get Insurance to Pay for Cosmetic Procedures

We usually think of cosmetic surgery as elective (and expensive) procedures that aren't covered by insurance, such as a facelift to make us look younger.

But some surgeries that improve us cosmetically are actually medically justified. The fact that the surgery makes you look better, or feel better about your looks, is secondary to the health benefits it can offer.

While facelifts are generally elective and not covered (unless they're part of a restorative procedure, such as reconstructing your face after surgery or an accident), you might be surprised at some of the procedures that are covered by your insurance.

Before you schedule anything, though, check your policy to see what coverage is offered for procedures such as those listed below, and make certain you have the proper referrals (if needed).

In almost all cases, you will likely have to pay for options that are not related to those procedures covered by insurance (which includes most things considered purely cosmetic or elective). But because you are having related surgery, your cost may be slightly less due to the portion of the surgery covered by insurance. You will also have the benefit of only one recovery period, rather than two or more, from having the surgeries done separately.

This patient was approved for upper eyelid surgery. The excess skin in the upper eyelid inhibits the range of vision. The patient also had elective surgery for fat pads and excess skin below the eyes.
MG (c) 2010

Health Insurance Coverage for Eye Lifts (Blepharoplasty)

Sagging upper eyelids are typically covered by many insurance firms. Even though your primary desire for getting the surgery might be your looks, insurance companies often cover this procedure because droopy eyelids impair your field of vision.

The Approval Process

The surgeon will take pictures and run simple tests (involving closing your eyes and slowly opening them) and submit the findings to your insurance firm. If the insurance firm agrees you have impaired vision (usually meaning that your eyelid covers a certain portion of your pupil when you open your eyes normally), this may be covered in your policy.

Who Is a Good Candidate for an Eye Lift?

If your upper eyelids have excess tissue or pads of fat, you might be a good candidate for this procedure (which, surprisingly, is generally outpatient and is not too difficult to go through). Bags and excess skin under your lower lids, as ugly as they are, probably aren't covered.

However, you can pay an additional fee to get this procedure done at the same time. You will pay for the extra time in the operating room as well as the additional time under an anesthetic and the cost of the surgery on the lower lids.

A tip: Look for an oculoplastic surgeon rather than just a cosmetic surgeon. These specialists are trained in protecting and restoring the muscular integrity of your eye rather than focusing on pulling and tightening the skin. In many cases, you will get a more natural result through their work than with a surgeon not similarly trained.

Recovery includes a few days of sleeping with your head elevated, putting ice packs on your eyes for a few days, and watching the bruises fade (usually within 2-4 weeks).

This patient's bunion protrudes and also shows signs of inflammation.
Cyberprout via Wikimedia. CC BY 1.0 Generic

Is a Bunionectomy Covered by Insurance?

Many people want to get rid of unsightly bunions—women want to have prettier feet, and they long to wear cute shoes. Men like the streamlined look they'll get without a bunion sticking out on the side of their shoe.

Kinds of Bunions and Coverage

Insurance companies don't care how you look or what shoes you want to wear, but they do have coverage to help get rid of the pain bunions cause. Large bunions are incredibly painful, and they hamper your daily life (even your safety, if your gait is altered to avoid the pain of your shoes rubbing against the bunions).

There are several types of bunion procedures, which can vary from a simple shaving of the protruding bone or growth to cutting the bone and rotating the angel of it (to move the big toe further away from your other toes). You may also need the muscle between your first two toes to be cut slightly if it doesn't allow your toes to spread apart sufficiently.

Insurance companies will evaluate the physician's report (which may include X-rays) and may also contact you with questions (hint—they want to know if your feet hurt or whether your motivation is to wear those cute shoes).

As with many other cosmetic surgeries, this is day surgery, and you go home a few hours afterward. You will be on crutches for a while, and then in a 'bunion booty,' and then in comfy shoes for several weeks. But after you recover, the pain will be gone or greatly reduced, and usually, you can indeed wear those cute shoes.

Rhinoplasty splint to aid healing
FacialSurgery via Wikimedia. CC BY 3.0

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Can Health Insurance Pay for a Nose Job (Rhinoplasty)?

No, you can't get surgery just to have a prettier nose—but you can get insurance coverage for surgery to correct a deviated septum and at the same time (for an additional fee) get an improved shape for your schnoz.

A deviated septum is a flaw (almost like a detour) in the cartilage and bone between your two nostrils. It closes down the airflow and keeps you from breathing fully. Because of that (and other factors, such as susceptibility to sinus problems), insurance companies pay for this surgery. Getting your nose reshaped, though, is generally not covered.

If you're considering this surgery, look for a surgeon skilled in the corrective procedure as well as the cosmetic portion if at all possible (otherwise, two surgeons will perform the surgery, which adds to the expense).

Recovery can be a few weeks and usually involves having your nostrils packed for a few days (which can be uncomfortable), meaning you will breathe through your mouth for that period of time.

Insurance Payments for Weight Loss Through Gastric Bypass or Banding (Bariatric Surgery)

One of the most extreme treatments for obesity is a gastric bypass (or a similar procedure). This surgery, sometimes called stomach bypass, can be quite dangerous, and you should examine all other options, including changes to your diet.

If specialists and your insurance firm all agree that this type of surgery is needed and that you are a good candidate for it, the procedure may be covered by your policy.

Several types of procedures can be done; some are more invasive than others, and the risks can vary with the type of procedure, your age, your general health, the amount of extra weight you carry, and other factors. All of these factors also affect the recovery time and amount of time you may spend in a facility.

Varicose veins are painful and hamper blood circulation.
NIH via Wikimedia. CC BY Public Domain

Will My Health Policy Pay for Varicose Vein Surgery?

Varicose veins are unsightly, but because they also cause pain and affect circulation, they can be covered by insurance. These are veins that have become inflamed, enlarged, and swollen with excess blood and fluid.

In some cases, people may not have as pronounced of symptoms as those in whom the veins are visibly engorged. If you have heaviness or tiredness in your legs, dark blue veins, or other symptoms, ask your doctor whether you might have this condition.

Your insurance will likely cover treatment (including surgery) for veins that truly need medical attention. As with many procedures, you will probably need a referral to a specialist.

Treatments can vary for this condition, which means recovery varies as well. Surgery for this condition will help address the appearance of the veins (but may leave scars) but will also help address the pain and other complications you might be experiencing.

Examples of Melanoma (On Left) vs. Normal Moles

Mole Removal Through Health Insurance

Although this is usually a minor procedure, it is often medically needed if a mole appears to be precancerous or can otherwise cause health complications.

The procedure will involve cutting or burning off the mole, and it may or may not require a small stitch or two. It is often done in the doctor's office and can sometimes require little more than a local anesthetic.

Because moles can detract from your appearance, you may personally feel it is a cosmetic choice, but insurance coverage will be based on whether the mole puts your health at risk.

If the tissue that's been removed looks suspicious, make certain a biopsy is performed to determine if there are cancerous cells.

Unless the mole is cancerous, recovery can be uncomplicated and will generally not require further treatment (unless your physician wants to examine your skin at a later date for additional growths). Cancerous moles require additional treatment, of course, and in either case, you should monitor your exposure to the sun and use effective sunscreen at all times.

Insurance Coverage for Breast Reduction or for Reconstructive Surgery After Mastectomy

Breast Reductions: Women whose breasts are abnormally large (to the point of inhibiting the quality of life or causing extreme pain and muscle strain) can often have breast reduction done through their insurance plan. There are risks to this surgery (as with any surgery), but there may be positive health trade-offs in the long term.

Breast Reconstruction: Persons who have had mastectomies are generally eligible for reconstructive surgery to restore the appearance and shape of the breast(s). This can include implants, cosmetic surgery to the skin and nipple, and applying a tattooed nipple.

While this is not the type of surgery one thinks of in terms of cosmetics, it indeed addresses the emotional look and physical appearance of those who need it. It is also comforting to know that insurance companies generally recognize this is a medically needed procedure.

Cosmetic Surgery Payment Options (Flex Accounts)

Some expenses for elective procedures might qualify for payment through Flex Health Accounts. Facelifts no longer qualify for this type of pretax savings plan, but several other elective procedures can be paid from your Flex Account. If you are considering any of the above procedures, or procedures such as the ones listed below, check with your plan administrator to see if you can set aside pre-tax dollars to pay for your share:

Radial Keratotomy
Dental Implants
Co-pays for any procedure covered by insurance

Things to Ask Your Doctor About Surgery

Before you agree to surgery, find out all you need to know about the risks, possible complications, side effects of anesthetics, choices of anesthetics, and other details to help you make your decision.

For insurance coverage, ask if the doctor takes assignment, which means they will accept payment directly from the insurance company rather than requiring you to pay in advance. If the surgery is not 100 percent covered (which will most likely be the case), find out the exact amount you will pay out of pocket. If the out-of-pocket expense is a large amount, ask about payment arrangements. Payment options or financing may be available through the clinic or surgery center you're using. Or, you may get a discount for paying in cash at the time of surgery.

Ask if you can speak to patients who have had the surgery. Most surgeons who do cosmetic work and procedures will have before and after photos available, as well as a list of previous patients who have given permission for you to contact them.

This article is accurate and true to the best of the author’s knowledge. Content is for informational or entertainment purposes only and does not substitute for personal counsel or professional advice in business, financial, legal, or technical matters.

Comments

Marcy Goodfleisch (author) from Planet Earth on May 23, 2012:

Hi, Simone! This was one of your Weekly Inspiration titles - so the thanks all goes to you! Some who commented here mentioned a few things that can be added, so I'll be including those as soon as I have a chance.

Simone Haruko Smith from San Francisco on May 23, 2012:

Goodness me, this Hub is incredibly useful! You're a human encyclopedia, Marcy Goodfleisch.

Marcy Goodfleisch (author) from Planet Earth on May 21, 2012:

I like your advice on keeping the paperwork - we have all seen instances where we had documentation on something and, had we not kept it, we would have had problems. Thanks so much for reading and for your excellent suggestion!

John Sarkis from Winter Haven, FL on May 21, 2012:

Hi Marcy, what an exceptional hub this is. I work in the field of medical administration. With procedures such as "eye lift," a letter of necessity from the surgeon makes a difference in getting the insurances to pay. Additionally, keep all copies of pertinent referrals and any other paperwork you have...paper trail is the key word when it comes to things like cosmetic surgery. Oftentimes people walked into doctor's offices and give the referral/authorization, etc..., and never ask for a copy---always get copies of any paperwork you might have. Voted up

John

Marcy Goodfleisch (author) from Planet Earth on May 19, 2012:

I was a bit surprised, too, alocsin - I think they're so visually noticeable that we classify that procedure as purely cosmetic. When I looked into it further, though, it made more sense. An overhanging upper lid restricts your field of vision quite a bit. So I understand it better now. Thanks so much for reading and commenting!

Aurelio Locsin from Orange County, CA on May 19, 2012:

All of these make sense as being medically necessary but I'm surprised that eyelids are covered as well. That would seem to be the most cosmetic. Voting this Up and Useful.

emilybee on May 18, 2012:

Hi Marcy-Yes, it was for TMJ (includes jaw pain, headaches, etc), and a huge overbite, too. Surgery was the only way to correct the overbite since I had braces when I was small and since I'm an adult and have stopped growing, merely braces wouldn't fix everything. Surgery was a bit extreme but results were awesome-so happy I had it done. It's outrageous (and unreasonable) though the cost of surgical procedures without insurance, very fortunate to have been covered by insurance at the time of my surgery.