Your Plastic Surgery Procedure May Be Covered by Insurance

Plastic Surgery Procedure Covered By Insurance

Plastic surgery is not just for cosmetics. Plastic surgeons also perform reconstructive and hand surgeries and depending on the case, your insurance may cover all or part of the procedure. Board Certified Plastic, Reconstructive and Hand Surgeon, Dr. Stacey June, explains what procedures your insurance company may cover below.

Skin

Whenever there is an opening in the skin or an opening needs to be made, your insurance company may pay for a plastic surgeon to care for it. Procedures that may be covered include:

  • Removal and closure of lesions, masses and cysts.
  • Removal and closure of skin cancer, including MOH’s defects (a specific type of cancer excision typically performed by dermatologists)
  • Acute and chronic wound management
  • Skin grafts
  • Flap procedures (borrowing tissue from another body part)
  • Burn treatment
  • Laceration repairs
  • Dog and animal bites

Eyes

Whenever there is an impairment of vision or improper eye closure, your insurance company may pay for a plastic surgeon to correct it. Covered procedures include:

  • Brow Lift: If a low eyebrow is heavy enough to interfere with vision, lifting the eyebrow into a higher position may improve your vision.
  • Upper Lid (Blepharoplasty): If extra skin between the eyebrow and eyelid begins to interfere with vision, this is called dermatochalasis. Removal of this skin, and occasionally fat/muscle, may improve your vision.
  • Ptosis Repair: If you are having difficulty opening your eyelids, it could be due to one of the muscles in the eyelid not functioning properly. This is called blepharoptosis and repairing the eyelid position may improve your vision.
  • Ectropion/Entropion Repair: If the eyelid margin is turned out (ectropion), or turned in (entropion), it could cause pain and dryness and may need to be surgically corrected.

Facial Fracture Repair

Broken bones in the face may need to be surgically corrected and should always be evaluated by a plastic surgeon within two weeks of the injury in case it needs repair. This repair would be covered by your insurance company.

  • Orbital Fractures: Trauma to and around the eye may cause a bone injury around the eye. If the bone is significantly displaced it could lead to long term problems like enophthalmos where the eyeball appears sunken in and the patient may have symptoms of double vision. Repair may or may not require the need of surgery and/or hardware.
  • Nasal Bone Fracture: This is more than just a crooked nose and can cause difficulty breathing. Repair can typically be performed as a closed reduction of the nasal bones which means no incision is required.
  • Zygoma (cheek bone) and Maxillary Fractures: These can lead to long term deformities including difficulty with dental alignment, opening and closing the mouth and chewing and should thus be evaluated.

Breasts

Whenever there is a problem with the breasts that interferes with daily living activities, or is caused by a cancer, your insurance company may cover the procedure.

  • Breast Reduction: If breasts are very large and causing other symptoms, your insurance may pay for them to be made smaller and more lifted. Symptoms that support the need for a breast reduction include: back and shoulder pain, grooves in shoulders from your bra, frequent and difficult to treat rashes under the breasts, difficulty finding appropriate fitting bras/clothing.
  • Breast Reconstruction: It is federally mandated that once an insurance company pays for a mastectomy, they must also cover reconstruction of that breast and necessary symmetry procedures for the other breast. This includes tissue expander/implant reconstruction, autologous tissue reconstruction (using another part of your body to reconstruct a breast), nipple and areola reconstruction including tattoos, fat transfer, breast enlargement/reduction/lifting of the opposite breast to improve symmetry. Even if the breast is only partially removed for cancer, such as the case of a lumpectomy or partial mastectomy, your insurance company may cover procedures to improve symmetry between your breasts.

Abdomen

Whenever there is a large pannus, extra skin that hangs from the lower abdomen like an apron, your insurance company may cover surgical repair. This is most often required in patients that have had major weight loss surgery or very large hernias.

  • Panniculectomy: This procedure involves the removal of extra skin that hangs from the lower abdomen like an apron. This tissue must be large enough to cause other symptoms such as back pain and frequent and difficult to control rashes. This is usually associated with patients who have had massive weight loss or very large hernias. The insurance company only pays for removal of the overhanging tissue. This is not the same as an abdominoplasty or a tummy tuck as it does not address the remainder of the abdomen.

Hands

Whenever there is an injury to the hand, acute or chronic, a plastic surgeon may be able to help and an insurance company will likely cover the procedure needed to improve function of your hand. If this injury is work related, it may be covered under workman’s compensation rather than your personal medical insurance.

  • Tendon Injuries/Repair: Tendons are rope-like structures of the hand that help bend the fingers, hands and wrists. These injuries are usually associated with trauma but can also occur spontaneously. Whenever there is difficulty moving through normal range of motion, you should be evaluated.
  • Nerve Injuries/Repair: Nerve injuries can occur acutely due to trauma or can occur slowly over time such as with carpal and cubital tunnel syndromes. Whenever there is alteration in the sensation or function of the hand, it should be evaluated.
    • Carpal Tunnel Syndrome causes chronic compression of the median nerve at the level of the wrist. There are conservative and surgical procedures that can help alleviate these symptoms which should be addressed early to prevent irreversible damage.
    • Cubital Tunnel Syndrome causes chronic compression of the ulnar nerve at the level of the elbow. There are conservative and surgical procedures that can help alleviate these symptoms which should be addressed early to prevent irreversible damage.
  • Fractures: Broken bones of the hand and fingers should be evaluated by the surgeon to see if conservative splinting versus surgical intervention (like pins, wires, plates, etc.) may be needed.
  • Partial and Complete Amputations: Often require emergent surgical intervention. The goal of surgery in the case of an amputation is to best improve function over length.
  • Dupuytren’s Contracture: A condition in which the fascial layers of the hand contract causing pits and eventual malposition of the hands. Injectable medications (Xiaflex) and surgical procedures (fasciectomy) may improve symptoms.
  • Trigger Fingers: Inflammation can cause difficulty in the tendons as they glide through the hand which will eventually cause the fingers to lock in certain positions. This may improve with conservative and surgical procedures and should be evaluated.
  • Ganglion Cysts and other hand masses: These may require surgical excision and should always be evaluated.

This information does not guarantee or promise insurance coverage for the procedures mentioned above. Advanced Specialty Care and our providers and employees cannot promise, guarantee or ensure insurance coverage. It is your responsibility to determine your specific insurance benefits and coverage for any procedures and treatments including knowing any pre-certification or pre-authorization requirements of your insurance plan. Our office can assist you with this process.

Appointments with Board Certified Plastic, Reconstructive and Hand Surgeons are available at Advanced Specialty Care’s offices in Danbury, CT, New Milford, CT, Norwalk, CT and Ridgefield, CT. Call (203) 840-4700 or click here to contact our office.

Topics: Blog, Cosmetic Surgery, Dr. Stacey June, Hand Surgery, Plastic Surgery