Is Plastic Surgery Covered by Insurance?

Are you considering a plastic surgery procedure and hoping that your insurance company will cover it? If that’s the case, there’s some good news!

Can my insurance pay for my cosmetic procedure? This question doesn’t always have a straight answer. Insurance coverage for a procedure is heavily influenced by a number of variables. The insurance company’s assessment of the procedure’s medical necessity is frequently the deciding factor.

What Cosmetic Surgery Procedures Are Insurance-Covered?

Cost is a role in almost everything we buy or do in life. Plastic surgery is the same way. Suppose you’re thinking about having cosmetic surgery done. In that case, it’s reasonable to be concerned about your financial commitments and whether a portion of the procedure will be covered by insurance.

The good news is that surgeries that are deemed “medically necessary” may be covered, even if they improve your physical attractiveness. Breast reduction to alleviate your sore back

 or extra skin removal after a major weight loss, are examples of procedures that may be covered. It all boils down to the insurance company and plan you choose.

Making a compelling case for why a procedure is medically essential and how it can improve your quality of life is key to securing insurance coverage. In other words, if your primary purpose is to improve your appearance, you’re unlikely to get your health insurance to cover cosmetic surgery. However, in many circumstances, this could be an extra benefit.

What is required to get my Insurance to cover my surgery?

Regrettably, there isn’t a simple answer to this question. “Medically essential” is defined differently by each firm and insurance plan. Insurance companies, on the other hand, make a clear distinction between reconstructive surgery — which includes procedures like breast reduction and eyelid surgery — and simply cosmetic surgery.

Reconstructive surgery 

Reconstructive surgery is done on aberrant structures that are caused by congenital malformations, developmental anomalies, trauma, infection, tumors, or disease. Surgery to improve function or restore a normal appearance is one example.

Insurance frequently covers reconstructive procedures to fix congenital abnormalities and trauma. You may be eligible to use insurance to pay for cosmetic surgery if you were born with malformed ears due to the birthing process or disease, or if you have significantly asymmetrical breasts.

Cosmetic surgery

Cosmetic surgery involves modifying normal body components to improve a patient’s self-esteem or physical attractiveness. Procedures like laser resurfacing to level out your skin tone or a Brazilian butt lift to sculpt your buttocks, for example, are unlikely to be covered.

Some insurance companies or plans consider if an illness has a detrimental influence on the patient’s daily routine. If it’s a physical problem that prevents them from performing daily duties like showering or exercising, or if it’s more of a nuisance, like not being able to run for a marathon. This is the distinction that may need to be made in the end.

Will skin removal surgery be covered by my insurance?

Treatment required to eliminate or lessen interference with “daily activities of living” may be reimbursed if a condition inhibits them. For example, if a patient has excess skin following weight loss that hangs down to the knees, this could be the case. Excess skin may obstruct additional physical activity or even daily movement, and surgery may be deemed medically required.

Even though the heavy, superfluous skin left over after weight reduction might be deemed a medical problem due to discomfort and an increased risk of skin disorders, most insurance companies will not pay for body lift surgery.

Costs for all our general procedures at VIDA can be found on our website. However, if you satisfy specific conditions, some insurance companies will cover a portion of your body lift costs. Here are a few examples:

  • You’ve shed almost 100 pounds.
  • You’ve maintained a consistent weight for at least six months.
  • You’ve had bariatric surgery, and it’s been at least a year since you had it.
  • Excess skin has caused skin diseases, which you have recorded.
  • A body lifting operation has been advised by your primary care physician.

What are my options for getting my plastic surgery covered by insurance?

In the end, it’s up to your insurance company to decide whether your operation is covered. However, there are a few things you can do to improve your chances of being approved for coverage and establishing that your surgery is medically essential, such as:

  • Keep precise notes of any visits to the doctor, hospital, or other medical facility related to your disease. This includes any therapy or product purchases.
  • You must be able to demonstrate that you have explored all other treatment choices and that surgery is your last resort.
  • Obtain documents from your doctor and other medical professionals stating that your desired operation should be conducted for medical or functional reasons.
  • Choose a qualified, credentialed, and reputable surgeon, as well as a treatment facility.

Which procedures for cosmetic surgery are commonly covered?

A few popular procedures, such as a Tummy Tuck are frequently covered by health insurance are listed below. It’s worth noting that numerous other procedures, such as ear surgery and even teeth straightening, may be covered in some cases.

Surgery weight loss

Many major insurance companies support weight-loss operations, including gastric bypasses, to some extent. Experimental procedures are rarely covered, while proven methods such as gastric sleeves, lap gastric bands, and gastric bypass are frequently covered.

Individuals with a high BMI and serious comorbidities (sleep apnea, heart disease, type 2 diabetes, cancer, and others) have a higher chance of getting weight loss treatments funded by insurance.

Excessive skin removal

Many people encounter extra skin after a significant weight loss, which can obstruct physical activities and create pain. In such circumstances, insurance may pay for panniculectomy surgery or a belly tuck.

However, because most cases of sagging skin are still regarded as simply aesthetic, this is not nearly as prevalent as coverage for weight-loss operations. In some situations, such as if you have a history of skin problems or are unable to exercise, insurance may pay the entire cost of the surgery.

At VIDA we understand how stressful it can be to have a legitimate medical condition yet be unable to obtain treatment due to a lack of insurance coverage. If you believe you may require medically essential plastic surgery and want to learn more about whether your treatment will be reimbursed by insurance, the first step is to schedule an appointment with one of our doctors. Call our clinic today to arrange your consultation and let us help you!


Dr. Alejandro Quiroz

Dr. Quiroz is our board-certified Chief Plastic Surgeon at VIDA Clinic in Tijuana. He specializes in Facial Rejuvenation, Neck lift, Buttock Augmentation, Breast Augmentation, Body Contouring and more. He is member of the American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons, International Society of Aesthetic Plastic Surgery, San Diego Plastic Surgery Society, the Mexican Society of Aesthetic & Reconstructive Plastic Surgery and the Mexican Council of Aesthetic & Reconstructive Plastic Surgery, to mention a few.