Plastic Surgeons Push for Coverage on Certain Procedures

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b2ap3_thumbnail_insurance.jpgEach year, millions of plastic surgery procedures are performed in America, and most of them are not covered by medical insurance. This means these costly procedures are often done at the expense of the patient, to the tune of over $12 billion dollars a year. But now, a growing number of plastic surgeons are pushing for health insurance providers to cover more plastic surgery procedures, as many procedures do improve the health and well-being of the patient.

"A popular example many surgeons are using is reconstructive surgery for transgender patients or breast cancer survivors," said Dr. Ryan Mitchell, a plastic surgeon based in Henderson, Nevada. "Many women opt to have breast augmentation following a mastectomy, but most insurance plans don’t cover augmentations. That leaves a woman who has just likely endured a grueling medical battle with the added expense of having to purchase what is essentially a prosthetic breast with her own money."

Ethics aside, this is also problematic because many cancer survivors are low on extra money following a lengthy recovery.

"Paying out of pocket may not be in their budget for some time following chemotherapy,  especially if the patient has been out work, or has had to pay for any portion of her treatment out of pocket," said Mitchell. 

Another problem Mitchell sees with billing cancer survivors for reconstruction is that were it any other body part, it would most likely be covered.

"If a patient loses a limb because they were doing something reckless, their insurance will most likely pay for a prosthetic, so why isn’t the same true for patients who develop breast cancer by no fault of their own?" said Mitchell. 

Ironically, some insurance plans do cover other breast-related procedures, such as breast reduction, if the size of the patient’s breasts significantly impact his or her quality of life.

"Large breasts can cause medical problems like chronic back and shoulder pain, and that’s why some insurance plans will cover reduction surgery," Mitchell said. "I know plans like Tricare will cover some breast surgeries, and reduction is included."

Other procedures that may be covered by standard health insurance include treatment of some skin conditions, such as excess skin following major weight loss, or mole removal, but only if the surgeon is concerned the mole may be cancerous and submits it for biopsy. In fact, many surgeons will submit moles or skin tags they know are most likely not cancerous, just to allow their patient to bill insurance for the removal

"It’s honestly a huge waste of money," said Mitchell. "You are essentially billing for an extra procedure that doesn’t need to be done, because the insurance company has decided to not cover any mole removals they deem cosmetic, even if the mole is bothering the patient and they aren’t removing it for cosmetic purposes."

According to Mitchell, some insurance policies will often cover some sinus surgeries, like septum straightening, but nothing more.

"Patients will frequently schedule a rhinoplasty alongside a septum correction to kill two birds with one stone, but the insurance will only pay for the actual septum straightening and a portion of the anesthesia, but the actual reshaping of the nose cannot be billed to insurance," said Mitchell.

Whether insurance companies will revise policies to include coverage for cosmetic procedures that are more medical than cosmetic remains to be seen, but surgeons like Mitchell won’t give up in the meantime.

"Medical care shouldn’t be a blanket ‘yes or no’ in any field. Every patient should be seen as an individual," said Mitchell. "We aren’t advocating every person who wants breast augmentation gets it for free, but in cases where the patient has a valid medical reason, there should be some room for coverage."

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