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How To Get Insurance To Pay For Plastic Surgery

Find Weight Loss Surgery Financial Help Today

Using Insurance for Plastic Surgery!

No matter your reasons for considering a procedure, there are many resources to help you meet your goals. Countless individuals have used GoFundMe for medical fundraising to help cover costsbecause the investment in your health and quality of life is well worth it. Tap into the power of medical crowdfunding today so you can live your healthiest life. to start your fundraiser and raise money for your bariatric procedure today.

The Appeals Process: Another Chance At Coverage

If your insurance company does not authorize payment for your reconstructive surgery, or if it agrees to pay only a small percentage of a claim, you may choose to appeal the decision.

Before beginning this process, carefully read your policy or benefits booklet. Make sure there is nothing in the plan that specifically excludes the type of care you received or are scheduled to receive.

In appealing the decision, your first step is to write a letter to the insurance company representative who signed the notification of denial. In the letter, explain why you feel the procedure should be covered and ask that your request be reviewed by a plastic surgeon certified by the American Board of Plastic Surgery.

Your appeal letter should also request a full explanation of why coverage is being denied or paid at a reduced level. Request that the claims supervisor send you a copy of the specific statement drawn from the policy or from the benefits booklet that explains why your coverage is limited or denied. Attach a copy of the denial notification and a copy of your doctors pre-authorization letter to again provide the statement of your surgeons fee, the applicable billing codes, and an ASPS Position Paper specific to your procedure. Position papers are available from your plastic surgeon.

If your insurance company responds favorably to your appeal, notify the commissioner of your successful appeal efforts with a second letter.

The Importance Of Insurance For Plastic Surgery

Choosing to have plastic surgery is a personal decision. Its an elective form of surgery that will permanently change a part of your body or one of your features. Whether you are striving to defy the aging process, want to change a feature on your body or are looking for ways to sculpt your body, plastic surgery offers you solutions. However, it is an option that will mean a considerable investment. To protect yourself, you need to consider the importance of insurance for plastic surgery to cover yourself in the event that you have any problems with your procedure.

Why Should You Have Insurance for Plastic Surgery?

Due to the fact that plastic surgery is elective, it will not be covered by your regular health insurance policy. You dont want to go into any type of cosmetic procedure without insurance. This type of surgery is intended to provide you with coverage in the event that you have complications during your surgery or while you are healing from your procedure.

Insurance for plastic surgery can also help you if you are not happy with your results after a procedure. When you make the decision to have plastic surgery, you have to deal with the cost of your procedure. That means either paying for your procedure out of pocket or using financing to cover your costs. The last thing you want is more expenses after your procedure because there was a problem.

Give Yourself Peace of Mind

Learn More About Insurance for Plastic Surgery

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What Is Functional Eyelid Surgery

To improve ones facial look, eyelid surgery is a standard procedure. The surgery reduces the appearance of aging by removing extra skin and fat from the upper eyelids. Puffy bags under the eyes can be reduced or eliminated with eyelid surgery by removing excess skin and tissue from the lower eyelids. Eyelid surgery conducted exclusively for aesthetic purposes is not covered by health insurance because it is deemed elective.

If eyelid surgery is deemed medically essential, it may be reimbursed by health insurance. The thick skin that hangs over the lash line and obstructs the line of sight is removed during functional eyelid surgery. Daily activities like driving, reading, and texting might be complicated if your vision is hampered by extra skin on your upper eyelids that hangs down.

In order to discover whether or not eyelid surgery is covered by your insurance, youll typically need to provide documentation such as a vision test. A board-certified eye doctor, such as an oculoplastic surgeon, must conduct the vision test. Patients who have vision problems will have their condition documented by the surgeon and sent to their insurance company for review. Depending on the patients unique insurance plan, the insurance company may cover all or part of the cost of eyelid surgery.

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How To Get Approved For Weight Loss Surgery In Mexico

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Since weight loss surgery costs around $15,000 $30,000+ in the US, more and more patients are heading over to Mexico to receive the procedure. Statistics show that almost 1.4 million Americans crossed the border in 2018 to undergo medical treatment including some form of bariatric surgery.

If your insurance carrier is refusing to cover your bariatric procedure and youre wondering how to get weight loss surgery approved in Mexico, here are some simple guidelines for you:

You have to meet the following criteria to be eligible for weight loss surgery in Mexico:

  • You must have a body mass index of 30-35
  • You must have BMI for gastric sleeve of 35-40+
  • You must be suffering from obesity-related illnesses like diabetes, breathing issues, heart problems, hypertension, etc.

Bariatric surgery in Mexico costs around $3,599 $5,500 for inpatient treatment. This means everything from ground transportation and hotel stay to cost of medications is included in this price tag. However, if you cant afford to pay for the surgery all at once, our Jet Medical Tourism® team can provide you with super affordable payment plans as well.

Recommended Reading: Who Qualifies For Bariatric Surgery

Do American Insurance Companies Pay For Weight Loss Surgery

According to the Affordable Care Act, any plan offered on the open exchange must cover bariatric surgery. However, there are still some insurance companies that do not cover bariatric surgery because they are sold off the open exchange.

If you did not purchase your insurance through this exchange, speak to your provider to find out if they offer coverage. Also, keep in mind that even if they will pay for bariatric surgery, insurance companies require you to meet specific criteria before they will pay and often do not cover costs in full.

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Financing Options For Your Plastic Surgery

We recommend two healthcare credit institutions to our patients:

Finance Your Procedure with CareCredit®

CareCredit® is a lending company created to cover out-of-pocket expenses for patients for a variety of healthcare-related costs. The lending company helps patients afford medically necessary or cosmetic procedures and treatments, which allows CareCredit® to provide different financing than the average credit card. You can choose from short-term and long-term financing, and your approval is designed to provide the credit line for ongoing and future purchases.

Finance Your Plastic Surgery with Alphaeon® Credit

Alphaeon® Credit is specifically for patients who are looking for financing assistance with board-certified plastic surgeons and dermatologists. This lending company is dedicated to helping you look and feel your best with special financing for purchases of $250 or more. Alphaeon® offers instant approval with an online application, as well as credit lines reaching $25,000. There are deferred interest plans for 6 or 12 months, and you can qualify for equal payment plans that last 12 months to 60 months.

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What Cosmetic Surgery Procedures Are Covered By Insurance

As with most of the things we buy or do in life, cost is a factor. The same goes for plastic surgery. If you are considering having a cosmetic procedure performed, it is only natural to wonder what financial obligations you will have and whether or not a portion of the procedure could be covered by insurance. The knowledgeable team at Après Plastic Surgery in Portland, OR is dedicated to providing the most exceptional level of care, including helping decipher the sometimes confusing world of insurance coverage as it applies to cosmetic surgery.

Is Breast Reduction Surgery Worth The Effort


You have to limit your activities for about a month after surgery, but you can return to work within a week. Other than that, theres very little downtime. Recovery from breast reduction surgery means avoiding underwire bras, but you may consider that a bonus.

The biggest benefit to going through the surgery approved by your insurance company is that youll feel so much better. You may even find that you can participate in sports and exercises that used to be out of your league. You experience no more back aches, neck strains or stiff, marked shoulders. The rash underneath your boobs clears up, never to return. Risks are rare when you rely on experts in breast reduction surgery, but all of them are easily manageable.

Maintain your ideal weight and the results are permanent. To begin the process of getting on your breast surgeons schedule, contact Rowe Plastic Surgery today. The staff works with you to determine what steps you need to take to get insurance approval. Theres no reason to wait. Visit the closest office in Manhattan, Plainview or Water Mill, NY or in Montclair or Red Bank, NJ.

  • New York – The Club House
  • 71 East 77th Street, 1A New York, NY 10075
  • 89 Valley Road, 1st Floor Montclair, NJ 07042
  • 100 Manetto Hill Road, #204 Plainview, NY 11803

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States Where Insurance Is Required To Cover Bariatric Surgery

Under the Affordable Care Acts Essential Health Benefits Benchmark Plans, 23 states require that all individual, family, and small group insurance plans cover bariatric surgery. Those states are:

Also under the ACA, in the following three states, bariatric surgery coverage must be offered in at least some policies:

  • Georgia, where a 1999 state law also mandates coverage for morbid obesity
  • Indiana, where a 2000 state law also mandates coverage for morbid obesity
  • Virginia, where a 2000 state law also mandates that coverage for morbid obesity must be offered in at least one plan by each state-regulated health insurer

Can My Nose Job Be Covered By Insurance

Rhinoplasty, commonly known as a nose job, is an interesting case where oftentimes patients have the procedure performed primarily for medical/functional reasons but receive the cosmetic benefits of the surgery secondarily. A large number of men and women undergo rhinoplasty to address a deviated septum, small nostrils, or other mechanical flaw, which obstructs nasal airflow and can lead to trouble breathing, difficulty sleeping, and even sleep apnea. In many of these cases, rhinoplasty will be considered a necessary procedure and, in turn, be covered by the patients insurer. As a result of the manipulation necessary during rhinoplasty, the patient may also achieve a more appealing nasal contour, even though the procedure was not intended as a cosmetic one.

During your initial consultation at Après Plastic Surgery, one of our exceptional board-certified plastic surgeons will thoroughly evaluate your situation, discuss your goals and concerns, and give you a realistic idea of what results are possible with your intended procedure and if there is an opportunity to receive any insurance benefits.

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Staying Informed About Your Health Care Costs

As you plan for plastic surgery, you will probably learn a lot about what will happen in the operating room and discuss with your plastic surgeon how you will look and feel afterward. However, another important part of being an informed patient is knowing about the costs associated with surgery, and how these costs will be paid.

The American Society of Plastic Surgeons has prepared this information to assist you in better understanding health insurance benefits for plastic surgery. It is intended to answer basic questions and guide you in communicating effectively with your plastic surgeons office staff and your insurance carrier. It wont answer all of your questions, because a lot depends on individual circumstances and your own insurance. Be sure to contact your insurance company or your employers Human Resources/Benefits department with any questions you have about coverage for specific services.

How Much Does A Mommy Makeover Cost

How To Get Insurance To Pay For Eyelid Surgery / Plastic Surgery ...

Due to the highly personalized nature of each mommy makeover surgery, the cost of the procedure will vary from patient to patient. Fortunately, it is often more cost-effective to undergo a mommy makeover which combines multiple procedures in a single surgical setting rather than having individual procedures performed separately, which can also add to your recovery time. Once you have had your consultation with Dr. Rao and determined a course of action, the knowledgeable staff at Rao Plastic & Hand Surgery will provide you with an estimate for your surgery and any associated fees so that you can make financial decisions and prepare accordingly.

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Does Health Insurance Cover Cosmetic Surgery

Updated on Thursday, June 24 2021 | 0 min. read by Bryan Ochalla and co-authored by Nick VinZant

Millions of Americans go under the knife every year to enhance their appearance in one way or another. Does health insurance cover those procedures?

Will your health insurance plan help you pay for that nose job youve always wanted?

Or will it cover an eyelid lift, breast augmentation, tummy tuck, or butt lift?

The answer to these questions depends mostly on what kind of insurance policy. Most cosmetic surgery, however, isnt covered by insurance. There are exceptions:

  • If the goal of the surgery is to enhance or improve your appearance, dont expect your insurance plan to pay for it.
  • If its aim is to repair a congenital defect or reconstruct a body part damaged by a burn, disease, or some sort of trauma, your policy may help out.

Thats just the gist, though. Keep reading to learn more about:

  • How various types of health plans treat cosmetic and plastic surgery.
  • Common exceptions
  • How to find out if your health insurance will or wont cover a procedure.
  • Your options if your insurance policy wont the procedure you need or want to have done.
  • How much you might pay for plastic or cosmetic surgery .

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How Can I Get My Insurance To Pay For Plastic Surgery

Regardless of the reason you need plastic surgery, theres no guarantee your health insurance provider will agree to cover the cost. Therefore, its always important to confirm your coverage with your provider before having any surgery, especially if youre depending on insurance to cover the cost. To confirm your coverage:

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Some Insurers May Offer Lifestyle Surgery Options As Part Of Your Plan Or Benefits

Some insurers offer a Lifestyle Surgery cover element or benefit as part of their private health plans.

Depending on the specific terms of the cover, such a plan may cover you for things like weight-loss surgery, ear reshaping, male and female breast reduction, and cosmetic treatments required after a weight-loss procedure like a gastric bypass or sleeve fitting.

However, even these plans tend to require your treatment to have been deemed clinically necessary. In addition, you will typically also have to contribute to treatment costs yourself. The contribution is usually a specific percentage of the total costs rather than your deductible.

Limitedbreast Implant Complications And Breast Reconstruction

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Breast implants arent always a one-and-done surgery. In some cases, they contract, rupture, cause pain, get infected, and do all sorts of things they arent supposed to do, says Dr. Cassileth, who has had breast augmentation patients whove needed 10 surgeries to correct their implants.

In the case of capsular contracture , the contracture is measured on a scale from Grade I to Grade IV. Grade IV means a very hard implant and is usually covered by insurance policies, says Dr. Cassileth. However, your insurance will cover only the capsulectomy and pain medications. It wont cover the new replacement implant or the acellular dermal matrix that may be used to shield it.

The removal of implant can also be covered, in the case of an infection, meaning your breast is red or has a sore spot, or if a silicone implant has ruptured. Finally, the Womens Health and Cancer Rights Act of 1998 requires all group health plans that pay for a mastectomy after a breast cancer diagnosis to also cover prostheses and reconstructive surgery procedures.

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How Can Patients Build A Case For Coverage

As a first step, reach out to your primary care physician, to get your breast-related symptoms on the record and ask for referrals to providers who can assess and possibly try to treat those issues. We recommend that patients establish care with a physical therapist, chiropractor, or orthopedist so there is documentation that they have sought medical management for their neck, back, and shoulder painand that these conservative treatments did not provide sufficient improvement in symptoms, says Dr. Mahmood. Additionally, they often need a note from a primary care physician, dermatologist, or gynecologist, reiterating their long-standing history of symptoms, including rashes in the breast folds.

It helps, Dr. Mahmood adds, if youve maintained a consistent weight over time, as this demonstrates that are not due to recent weight gain. For women over 40, she also suggests getting a mammogram, if you havent had one recently, to avoid scheduling delays if and when your carrier greenlights your breast reduction.

When it comes time to meet with a plastic surgeon, check to see if your insurance plan limits you to in-network providers or allows you to see the surgeon of your choice. Youll also want to confirm that your preferred physician takes insurance not all do.

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