Insurance FAQ

Will my plastic surgery procedure be covered by health insurance?

Many cosmetic procedures are covered by health insurance if they can be shown to be medically necessary. Our knowledgeable office staff will work with your doctor and your health insurance provider to prepare the proper documentation in order to obtain insurance authorization where possible.

In cases where procedures are not medically necessary or we cannot obtain authorization, the costs of the cosmetic procedures may be defrayed by doing medically necessary procedures (such as gynecological procedures, gall bladder surgery or hernia repair) at the same time.

Does insurance usually cover tummy tuck surgery?

Tummy tucks or panniculectomies are considered medically necessary when a large amount of weight loss has resulted in overhanging abdominal skin and fat. This overhang may cause chronic infections, itching and rashes.

Proper documentation from your primary care physician must show that conservative treatment for this problem has been attempted and has failed. Different insurance companies have different criteria and exclusions, and we will be happy to review your coverage and work with your primary care doctor’s office to make authorization as simple as possible for you.

Does insurance usually cover breast reduction surgery?

Breast reduction or reduction mammaplasty is generally considered medically necessary by health insurance companies if you have documented symptoms of back and shoulder pain with your family physician. We will also need to show that you have at least 500 grams of tissue to be removed on each breast.

Proper documentation from your primary care physician must show that conservative treatment for your back and shoulder pain has been attempted and has failed. As with any procedure, different insurance companies have different criteria and exclusions, and we will work with you and your team to review your coverage and simplify the authorization process.

Does insurance cover breast lift surgery?

Breast lifts or mastopexies are considered medically necessary when a large amount of weight loss has resulted in overhanging breast skin that causes chronic infections, itching and rashes. As in the case of a tummy tuck and breast reduction, proper documentation from your primary care physician must show that conservative treatment has been attempted and has failed.

As in the above procedures, different insurance companies have different criteria and exclusions. We will happily review your coverage and work with you and your primary care doctors office to facilitate authorization.

Will insurance cover breast reconstruction surgery?

Breast reconstruction for patients that have had mastectomies for breast cancer is nearly always covered by health insurance companies because of federally mandated rules passed by Congress. We will review your coverage and work with you and your healthcare team to get authorization.

Which other procedures might be covered by my health insurance?

Cosmetic surgery insurance coverage can sometimes be obtained for the following procedures:

Thigh Lift

Thigh lifts or thighplasties are considered medically necessary when a large amount of weight loss has resulted in overhanging thigh skin that causes chronic infections, itching and rashes.

Arm Lift

Arm lifts or brachioplasties are considered medically necessary when a large amount of weight loss has resulted in overhanging arm skin that causes chronic infections, itching and rashes.

With both of these procedures, as with the procedures above, proper documentation from your primary care physician must show that conservative treatment has been attempted and has failed. Different insurance companies have different criteria and exclusions, and we will be happy to review your coverage and work with your primary care doctors office to facilitate authorization.

What do you mean when you say you can combine other medically necessary surgeries to obtain insurance coverage?

Hernias & Hysterectomies

When cosmetic procedures are not covered by your health insurance, one way of decreasing costs is by having a medically covered procedure done at the same time. These procedures can be coordinated with your gynecologist or general surgeon. By doing both procedures at the same time, you reduce risk by avoiding an extra trip to the operating room and extra anesthesia, and the cost is decreased because hospital and anesthesia fees are often discounted.

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