For Many Patients, Cosmetic Ear Surgery May Be Covered by Insurance

Most plastic surgeries are not covered by insurance. Insurance providers view them as optional procedures to improve the way an individual looks, but not medically necessary. However, for many individuals, cosmetic ear surgery may be covered by insurance.

Why It’s Different

Cosmetic ear surgery, particularly for cases in which an individual was born with a deformity, is considered reconstruction of a missing body part. While it may not serve a medical purpose, insurance providers deem this type of reconstruction something worth covering. Of course, every insurance provider is different, but if you are considering this procedure, you may want to ask.

Types of Surgeries Covered

There are different types of surgeries that can be performed on the ears. Some are more likely to be covered than others. For example, children born with small, non-functioning ears, usually just one of them, have a condition known as microtia. This is almost always considered a condition worth fixing by medical insurance providers. With the right surgeon, this cosmetic ear surgery is combined with a middle ear reconstruction that restores hearing to the child.

On the other hand, otoplasty, or the correction of overly large ears, is not as universally covered. If the insurance provider views it as a disfigurement from improper development that should be corrected, then the procedure is covered. If it is viewed as an entirely voluntary procedure, it is not. You will need to check with your service provider to see if they are willing to cover it. Before you do, talk to the surgeon you have chosen to see if there is a way to discuss the procedure that will make it more likely that it will be covered.

Cosmetic ear surgery that occurs after a trauma is a case by case scenario. Some insurance providers have plans in place that allow for reconstructive procedures on any body part after an accident or trauma. Others may view this as unnecessary if the body part can be saved with some damage without reconstruction. However, if a patient loses one or both of his ears, reconstruction is almost always a covered procedure.

These are the three main scenarios that cause patients to turn to plastic surgeries for their ears, and each of them is possibly covered by insurance. If you or your child has a problem with your ears, consider consulting with a qualified surgeon to see whether or not insurance coverage is a possibility.

What to Do If It’s Not Covered

Sometimes no matter what you try, the cosmetic ear surgery you need is not covered. In this case, talk to the doctor about payment options. For minor procedures, you may be able to set up payment plans to help you stretch out the payment over time. If you have a child with a deformity that should be corrected, consider hosting community fundraisers to help raise the money. Often members of the community will come together when a child’s health and well-being are at stake, so do not assume you cannot have the procedure if your insurance denies coverage. You have options available to help you cover the cost.