Plastic Surgery Is Sometimes Necessary

Deviated Septum Correction

People who are born with a deviated septum may experience breathing problems, frequent sinus infections, or heavy snoring. Sometimes the procedure to fix the problem combines an internal nasal procedure with a cosmetic procedure that ensures the nose looks correct when finished.

Certain Reconstruction Surgeries

If you have a body part damaged after an accident or after certain surgeries, your insurance and doctor may deem plastic surgery to be medically necessary. For instance, if you suffer from a dog bite or are in a car accident and have the potential for significant scarring, cosmetic procedures to reduce the scarring and restore your previous appearance may be necessary. Also, many patients who have mastectomies for breast cancer may be able to have reconstruction procedures done under insurance coverage as considered medically necessary.

Birth Defects

Children born with certain types of birth defects may benefit from plastic surgery, and this may be deemed medically necessary. For instance, children born with a cleft palate and disfigured upper lip may not be able to nurse or suck due to their birth defect. A cosmetic surgeon can reconstruct the lip and help the child learn the natural way to eat and drink. Children who are born with webbed toes or fingers can have the webbing removed to restore a more natural appearance. Those born with facial bone defects may be able to have reconstructive procedures to restore their appearance, and often this is considered medically necessary because the facial defects interfere with the person’s ability to eat, talk, or otherwise function properly. These are just some of the many birth defects that may qualify for medically necessary cosmetic procedures.

Eyelid Procedures

Typically, eyelid cosmetic procedures are not considered medically necessary. However, some patients who have excessively drooping eyelids may qualify for medically necessary plastic surgery because their condition is affecting their ability to see. In this case, insurance may pay for the .

Considerations

If your goal in determining whether or not a procedure is medically necessary is to get insurance coverage for your procedure, talk to your surgeon. Doctors often know how to code a particular plastic surgery to ensure that it is covered. Your doctor’s staff may also be able to negotiate with your insurance provider on your behalf. If not, call your insurance provider, and make a case for the necessity of your procedure. Read your explanation of benefits carefully, and be prepared to argue in favor of your procedure if you need to. With the doctor on your side and a true medical condition to fix, you likely can get insurance coverage for your next cosmetic procedure.