What Insurance Covers Cosmetic Surgery

What Insurance Covers Cosmetic Surgery?

Like most things we buy or pursue in life, plastic surgery has a cost that should be carefully considered. It’s normal to be worried about the financial commitments associated with cosmetic procedures and the potential for insurance to cover some of the costs if you’re considering having one.

Our skilled staff at Dr. George Brennan – Cosmetic Surgeon Newport Beach, is dedicated to providing the best possible care, which includes guiding you through the frequently complex world of insurance coverage for cosmetic surgery.

Does Insurance Cover Plastic Surgery?

This question only sometimes has a clear-cut solution. Numerous factors play a significant role in determining if a procedure is covered by insurance. If the insurance company believes the surgery is medically required, it is often the deciding factor.

Therefore, procedures that are solely cosmetic are not covered. For instance, insurance would not be able to pay for a patient who wanted a facelift to address cosmetic indicators of aging. 

Nonetheless, there are some circumstances in which aesthetic procedures might be considered essential for functionality or general health. For example, many people experience visual impairment due to extra skin on their eyelids that hangs down into their field of view. In this case, an insurance company may pay a portion of the cost of a blepharoplasty, often known as eyelid surgery or eyelid lift. 

A further procedure that may occasionally be demonstrated to be medically required is a panniculectomy, which involves removing the extra skin from the lower abdomen (pannus). Some people who have lost weight experience substantial mobility impairments due to hanging skin, leading to chronic skin rashes, infections, and irritation.

What Cosmetic Surgeries Do Insurance Usually Cover?

Saying that a particular procedure is “often” covered by insurance is challenging because judgments and specifics of coverage might differ significantly between cases. 

Once more, the reason for the surgery usually determines whether the procedure is reimbursed by insurance. The following are a few popular cosmetic procedures with benefits that can be justified for insurance coverage:

  • Rhinoplasty: in the case of problems with breathing or sleeping.
  • Blepharoplasty: if there is visual impairment.
  • Breast implant removal: in the event of a disease linked to breast implants.
  • Skin removal surgery: in the event of an infection, persistent rash, or other condition.
  • Breast augmentation or breast reconstruction: concerning breast cancer mastectomy cases.

Can My Insurance Cover My Nose Job?

Rhinoplasty, a “nose job,” is an intriguing example. Patients frequently undergo the procedure initially for practical or medical reasons, with the secondary benefit of an improved appearance. 

Many men and women have rhinoplasty procedures to correct deviated septums, narrow nostrils, and other mechanical defects that impede nasal airflow and cause breathing problems, sleep disturbances, or sleep apnea. The patient’s insurer often funds rhinoplasty because it is an essential treatment. 

Even though rhinoplasty was not meant to be a cosmetic treatment, the patient may also attain a more pleasing nasal contour due to the manipulation required during the procedure. 

One of our outstanding board-certified plastic surgeons will carefully assess your case during the initial consultation with Dr. George Brennan – Cosmetic Surgeon Newport Beach. They will also review your goals and concerns with you and give you a realistic estimate of the results you can expect from your planned procedure and information on whether you may be eligible for insurance benefits.

What Insurance Covers Cosmetic Surgery In Orange County

How Can I Get Insurance To Cover My Plastic Surgery?

Ultimately, it is up to the insurance provider to decide if your surgery will be covered. However, there are a few things you could do to increase your chances of getting accepted for coverage and demonstrate the necessity of the procedure from a medical standpoint, such as:

  • Record your condition with photos and logs.
  • Maintain thorough records of all of your visits to the hospital, doctor, and other relevant facilities. It covers the cost of any products or treatments.
  • Be prepared to show that surgery is your last resort after trying every other method of treatment for your condition.
  • Obtain statements endorsing the need for your planned operation to be conducted for functional or medical reasons from your plastic surgeon and other medical professionals.
  • Choose a trustworthy, licensed, skilled plastic surgeon and a treatment facility.

The compassionate team at Dr. George Brennan – Cosmetic Surgeon Newport Beach, is aware of how upsetting it can be to have a legitimate condition but not be able to secure insurance to fund the necessary care.

Why Do Insurance Policies Not Cover Cosmetic Surgery?

Because cosmetic surgery is regarded as an elective procedure that isn’t medically required, health insurance usually does not cover it. Health insurance aims to pay for required medical procedures to treat or improve a patient’s illness or injury. 

On the contrary, cosmetic surgery is typically done to improve a person’s appearance and isn’t considered medically required. Procedures for cosmetic surgery include facelifts, liposuction, and breast augmentation. 

In particular situations, such as reconstructive surgery following a mastectomy or other disfiguring injuries, cosmetic surgery may be considered medically required. In some cases, the procedure’s cost might be covered by insurance. 

It’s crucial to remember that insurance plans differ significantly, and some might pay for specific cosmetic operations if they are determined to be medically essential. Patients shouldn’t, however, often count on their insurance to pay for elective cosmetic surgery procedures.

What Is A Medically Needed Reason For Getting A Tummy Tuck?

Although most tummy tucks are done for aesthetic purposes, there are particular situations where the procedure can be considered medically necessary. 

The following are some examples of medically required reasons for a tummy tuck:

  • Correcting muscle separation: Diastasis recti is the term for the separation of the abdominal wall muscles brought on by pregnancy, weight increase, and aging. Digestive issues, bad posture, and back pain may result from this. This separation can be fixed with a tummy tuck by tightening your abdominal muscles.
  • Excess skin removal after weight loss: The skin around the abdomen may become loose and stretched out after a significant weight loss. It may result in infections, irritated skin, and trouble finding fit clothes. A tummy tuck can enhance the patient’s quality of life by removing extra skin.
  • Treating hernias: Some people may get abdominal hernias that need to be repaired by surgery. Concurrently, performing a tummy tuck with a hernia repair can treat the medical condition and enhance the appearance of the abdominal region.

It’s crucial to remember that insurance rarely covers tummy tucks and often only does so in situations when the treatment is considered medically necessary. Patients should check with the insurance company to see if a tummy tuck can be covered, as every insurance policy is unique.

What Insurance Covers Cosmetic Surgery In Orange County, California

What Should You Do If You Can’t Afford Plastic Surgery?

If plastic surgery is outside your budget, you might want to think about the following options:

  • Save money for the procedure. If the surgery you want isn’t urgent, you can think about gradually saving enough for it. You can make a budget and save money every month until the procedure’s cost is covered.
  • Look for financing options: To assist patients in covering the cost of their treatments over time, many plastic surgeons provide financing options, including loans, credit cards, or payment plans. You can also consider taking out a personal loan or utilizing a medical credit card to pay the expenses.
  • Look into less expensive options: There might be less expensive alternatives to this treatment or surgery that can produce similar results. Botox and dermal fillers, for instance, are examples of non-surgical treatments that can help minimize the effects of aging without the expense and recovery time of surgery.
  • Consider medical tourism: Plastic surgery procedures could be less expensive abroad than in your country. Before considering medical tourism, conducting comprehensive research on the surgeon, the facility, and the safety standards is imperative.
  • Consult with a nonprofit organization: Help is available from certain nonprofit groups for those needing medical procedures who cannot pay for them. You might look into organizations that offer financing or cheaper options for procedures, including plastic surgery.

It’s critical to keep in mind that having plastic surgery is an individual decision where your safety and health come first.

It could be preferable to put off the procedure until you have the money or look into other options if you cannot afford it right now.


Here are some frequently asked questions.

Are there any exclusions or limitations to cosmetic surgery insurance coverage?

Yes, most cosmetic surgery insurance policies have exclusions and limitations. These may include restrictions on coverage for certain procedures deemed purely cosmetic, limitations on coverage amounts, pre-existing condition exclusions, and requirements for medical necessity documentation.

Is pre-authorization required for cosmetic surgery insurance coverage?

In many cases, pre-authorization is required for cosmetic surgery insurance coverage. It means that the individual must obtain approval from the insurance provider before undergoing a covered procedure. Pre-authorization typically involves submitting documentation from a healthcare provider, including the diagnosis, proposed treatment plan, and estimated costs.

How does reimbursement work with cosmetic surgery insurance?

Reimbursement with cosmetic surgery insurance typically involves submitting a claim to the insurance provider after the covered procedure is completed. The insured individual or their healthcare provider submits documentation, such as receipts and medical records, to the insurer for review. If the claim is approved, the insurer reimburses the individual for eligible expenses according to the policy terms.

Call Us To Find Out If Insurance Covers Plastic Surgery Procedures

If you’re considering medically necessary plastic surgery and you’re wondering if insurance might cover it, your initial course of action should involve scheduling an evaluation with Dr. George Brennan, a specialized Cosmetic Surgeon based in Newport Beach. During this consultation, Dr. Brennan can assess your medical needs and discuss whether the procedure qualifies for insurance coverage. This crucial first step allows you to gather essential information about your options and make informed decisions regarding your healthcare journey.

Contact us today to book your consultation appointment at our convenient Newport Beach office. Simply dial (949) 644-1641, and let us help you!