Cosmetic Surgery and Insurance: When is a Procedure Covered?

A few years ago, cosmetic surgery was considered “optional.” Therefore, insurance would not cover procedures, even when they were greatly needed. While it is still somewhat a financial luxury, plastic surgery Toronto is not just for the wealthy anymore.

Cosmetic surgery is more affordable today thanks to a combination of insurance options, payment plans from providers, and technology. Do not, however, assume that your procedure is covered by insurance. Instead, consider the factors, type of procedure, and consult with your provider to find out your level of coverage.

Cosmetic Surgery and Insurance

Are Cosmetic Procedures Covered by Health Insurance?

For most cases, cosmetic procedures are still not covered. This is because insurance companies view cosmetic procedures as optional. Because they are not life-threatening or required to improve a patient’s health, they are non-essential.

If, however, cosmetic surgery is medically necessary, insurance will cover the procedure. You may find arguing the medical necessity of a procedure with an insurer quite complicated, though.

Insurance companies use multiple factors when determining what cosmetic surgery in Toronto they will cover, including:

  • Policy Wording – The specific wording of clauses and coverage in a health insurance policy can determine if the procedure is covered. Some policies have coverage in place for reconstructive surgery after an accident or correcting a deviated septum so that a patient can breathe.
  • Elective versus Necessary – The insurance company wants to see that a procedure is medically necessary and not considered “elective.” A patient receiving a breast augmentation for no other reason than wanting a larger breast size is not medically necessary. A patient requiring a breast reduction for chronic back pain, however, may be covered for the procedure.
  • Physical Dysfunction – When cosmetic procedures are correcting a physical dysfunction, insurance may cover the procedure. Determining if there is a valid physical dysfunction is up to a physician, not the cosmetic surgeon.
  • Psychological Stress – In some cases, insurance may cover a cosmetic procedure because the patient suffers emotional distress from their condition. For example, a dog attack victim with multiple facial scars could suffer severe depression. Insurance may cover reconstructive surgery to correct the scarring.

Cosmetic Procedures Covered by Health Insurance

What Can a Patient Do When Insurance Does Not Cover Cosmetic Surgery?

First, check with your insurer and physician to see if you can receive coverage for your procedure. If you have no medical reason to have the procedure, and you cannot receive coverage, your cosmetic surgeon may have options so that you can still receive the procedure.

When you want cosmetic surgery in Toronto, come to UELC. We have upfront pricing for our patients, and we can help you achieve your desired results while staying within your budget.

To make a cosmetic procedure more affordable, we offer financing options that include affordable monthly payments. Before worrying about how much your procedure will cost, you need to consult with our surgeon and see which procedure is right for you.

Call 416-653-8352 to schedule your consultation appointment or contact us online to learn more about paying for your plastic surgery in Toronto at UELC.

Leave a Reply

Your email address will not be published. Required fields are marked *