Insurance Companies and What is Covered
Health insurance policies can vary on what is considered a covered medical procedure. Most insurance companies follow the definitions given by the AMA (American Medical Association) and the ASPS (American Society of Plastic Surgeons) which state that there are two types of surgery when discussing plastic surgery - reconstructive and cosmetic surgery. Luckily, there are guidelines insurance companies must follow when it comes to defining what is considered reconstructive and what is considered cosmetic.
Reconstructive Surgery
Reconstructive surgery refers to surgery performed on abnormal structures caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease. These typically include;
Abdominal Surgery: If performed to improve or eliminate health problems such as back pain, sores, hernia, rashes, or to help improve your ability to walk normally.
Breast Surgery: If performed to correct asymmetry, reduce large breasts causing health problems, reconstruction due to loss, congenital absence (born with only one breast), or to reduce large male breasts.
Ear Surgery: If performed to correct deformed ears by birth, disease, or injury.
Eyelid Surgery: If performed to correct drooping eyelids that are causing vision problems or correct eyelids that are turned in an abnormal way.
Facial Surgery: If performed to balance the appearance if caused by paralysis, or to treat deformities in the facial muscles, head, or neck.
Hand Surgery: If performed to treat carpal tunnel syndrome, Dupuytren's contracture, nerve injuries, tendon injuries, fused fingers, or other deformities.
Nasal Surgery: If performed to correct deformities resulting from birth, disease, or problems with breathing.
Cosmetic Surgery
Cosmetic surgery is the reshaping of normal structures on the body to improve the self-esteem or appearance of a patient. These typically include physical improvements that are not medically necessary. Such as breast enlargement procedures, nose jobs (rhinoplasty), face lifts, hair transplants or laser hair removal, elimination of spider veins other such 'appearance' type medical procedures.
Researching Your Procedure
Read your health insurance plan booklet. You will likely find quick answers about surgeries covered, the appeals process and your expected deductible for the procedure.
Every health insurance company has a list of pre-approved medical procedures. So the direct method of contacting your health insurance provider will save you a lot of time when finding out if the exact procedure you need to have, or would like to have, is covered. Ask about exceptions, rule changes or special considerations. If possible, ask them to mail or fax you an approval letter or document outlining the coverage of the procedure you are asking about.
When speaking with your health insurance PPO or HMO provider, make sure you understand all details. Some insurance companies may cover the initial operation, but not the "post-op" complications or touch-ups. Some may not cover the surgery but will protect you in case of problems later on. Some may just cover prescriptions and short-term disability.
Before any type of surgery, discuss the procedure with your doctor and insurance carrier to determine what coverage, if any, you can expect.
Jason Perry
InsWeb, a top-rated online insurance marketplace, allows consumers to receive insurance quotes from a variety of health insurance providers. For more information on InsWeb, or to look for a health insurance agent in your area, visit http://www.insweb.com
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