Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted on Help Smart Phone and MEL Magazine.

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Dan Walker graduated with a BS in Administrative Management in 2005 and has been working in his family’s insurance agency, FCI Agency, for 15 years. He is licensed as an agent to write property and casualty insurance, including home, auto, umbrella, and dwelling fire insurance. He’s also been featured on sites like Reviews.com.

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Reviewed by Daniel Walker
Licensed Auto Insurance Agent

UPDATED: Mar 19, 2020

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Doctor examines plastic surgery patient as the discuss whether health insurance will pay for the procedure.

Almost all insurance companies cover plastic surgery, but the conditions under which they cover plastic surgery are very specific. This means that in some cases it will be covered and in other cases it will not.

The following article will provide additional information as to when plastic surgery is covered and when it is not. To obtain online insurance quotes for your health coverage use the free tool provided on this page now!

When is plastic surgery covered by a health insurance company?

Plastic surgery is covered by health insurance in very specific situations. The first situation is the disfigurement of a child. This can be due to a birth defect, genetics, a childhood disease, or a childhood accident. It does not have to be medically necessary since it is well understood that children can have emotional consequences from growing up with a disfigurement.

Health insurance also covers plastic surgery for adults when the injury in need of repair is the result of an accident. The injury may be the result of a car accident, a fire, a work related accident, a severed limb, or a chemical burn. If the injury requires any type of skin graft, this too is a plastic surgery procedure and is typically covered by health insurance.

You may even have an injury that you don’t realize needs to be fixed by a plastic surgeon, such a deep wound that could lead to scarring. This too is covered.

Another type of problem requiring plastic surgery that is covered by health insurance is any condition that blocks or lessens bodily functions. This relates to urination, bowel movements, and stomach or digestion issues. The cause of the lessened function does not matter. If your bodily functions are not working properly and it can be fixed by plastic surgery, your insurance will cover it.

Any plastic surgery that can correct a problem with vision, smelling, eating, or hearing is also usually covered. This includes procedures such as cochlear implants for the deaf and eye surgery for the legally blind.

Eating issues can involve the lips, tongue, neck or teeth. Since these are all essential functions deemed necessary to live a life of quality, they are covered under health insurance. Some companies will only cover this if it was caused by an accident or you were born with the problem. They will not cover it in the case of self-infliction.

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What about cancer reconstructions?

Procedures that differ among health insurance companies are procedures necessary for reconstruction due to cancer. For example, breast reconstruction after a mastectomy, skin reconstruction after the removal of skin cancer, or a reconstruction after the removal of a tumor.

If these procedures are not considered medically necessary for survival, some insurance companies will not cover the reconstruction. There are organizations that help provide free reconstructive plastic surgery for cancer victims through the volunteerism of doctors and nurses.

What type of plastic surgery is not covered by health insurance?

There are many types of plastic surgery that are not covered by health insurance. Mainly, any procedure that is not medically necessary for an adult will not be covered. As stated before, children will often be covered even for procedures that are elective. Non-medically necessary procedures include facelifts, breast enlargement, tummy tucks, and other procedures meant to change your appearance. The only procedure that may be covered is breast reduction if it is determined that the size of the breasts cause severe back or shoulder pain.

Unfortunately, this is true even if it is a disfigurement. In some cases an adult may have a disfigurement that was not treated in childhood for whatever reason, and as an adult they want the problem fixed. If it is not medically necessary, it will not be covered. Some new health industry legislation is trying to incorporate emotionally necessary procedures into the required coverage of health insurance companies. The problem is that what is emotionally necessary for one person is different than what is emotionally necessary for another person.

If you are in need of or considering plastic surgery or if you just need more information about health insurance companies, go online. Use an online health insurance comparison tool to compare rates and quotes from many different companies so you can see if what you need will be covered. Narrowing down your choices will save you time and remove some of the stress of trying to find a health insurance company. Try an online comparison tool today!