Does Health Insurance Cover Complications From Plastic Surgery

Health insurance coverage for plastic surgery complications varies by plan and complication type.

Patients should discuss coverage with their insurance and surgeon before the procedure.

What Are Plastic Surgery Complications?

Plastic surgery complications concern potential adverse events post-surgery.

This post explains what they are, how often they happen, and if health insurance typically covers them.

Examples include:

  • Hematoma (blood under the skin)
  • Infection (bacteria in wounds)
  • Seroma (fluid buildup under the skin)
  • Numbness (nerve damage)
  • Scarring (excessive or raised)
  • Anesthesia issues (heart attacks, strokes, allergies)
  • Wound dehiscence (incision rupture).
Plastic surgery complications
Complications form plastic surgery: Photo source (Sapling)

How Frequently Do They Occur?

Plastic surgery complications are rare, with serious issues happening in under 1% of cosmetic surgeries, but complex procedures like tummy tucks or facelifts may have slightly higher risks.

Is It Covered By Health Insurance?

Most health insurance won’t cover plastic surgery complications, especially for elective procedures.

Some policies might cover complications from medically necessary reconstructive surgery. Always check with your insurance provider for specifics.

Complications are rare, but it’s crucial to choose an experienced surgeon and weigh risks and benefits before deciding.

Overview Of Health Insurance Policies

Health insurance policies are designed to protect us if unexpected health issues arise.

But, what are the details of your insurance policy when it comes to plastic surgery-related complications?

In this blog post section, we’ll give a thorough overview of different types of health insurance policies that may cover such complications and help you better understand their exclusions and limitations.

Explanation Of What Health Insurance Is And How It Works

  • Health insurance is a contract between you and your insurance company, which helps cover your medical costs in case of any unexpected health condition.
  • Generally, you pay a monthly premium, and in return, the insurance company negotiates with medical service providers to offer services at a lower rate. The medical service costs are divided into the insurer and covered members.
  • When an unexpected health situation arises, you’ll need to check with your insurance policy first to understand what is covered by the insurance policies.

Types Of Health Insurance Policies That Cover Plastic Surgery

Not all health insurance covers plastic surgery complication. Coverage depends on the type of surgery.

  • Medicare: Covers medically necessary plastic surgery after breast cancer mastectomy.
  • Medicaid: State-dependent coverage for plastic surgery, criteria vary.
  • Private health insurance: Some cover medically necessary or procedure-related complications.

Exclusions And Limitations

Health insurance covers plastic surgery complications but has limitations:

  • Pre-existing conditions related to complications may not be covered.
  • Cosmetic procedures usually not covered unless medically necessary.
  • You may need in-network providers to avoid higher costs.
  • Deductibles, co-payments, or coinsurance may apply. Understand your policy and what’s medically necessary.

Plastic Surgery Coverage By Different Types Of Health Insurance

Concerned about plastic surgery costs? Explore health insurance options:

  • Medicaid: Usually doesn’t cover cosmetic surgery but may for medical necessity, like breast reconstruction after a mastectomy.
  • Medicare: Typically no for cosmetic surgery but may cover medically necessary procedures, such as post-accident or illness reconstruction.
  • Private Insurance: Coverage varies by policy.
  • Employer-Sponsored Insurance: Varies by policy.
  • Affordable Care Act Insurance: Covers essential health benefits, but plastic surgery coverage depends on the specific plan. Discuss your policy with your insurance provider for clarity.

Eligibility For Plastic Surgery Coverage

Criteria For Coverage

When it comes to health insurance policies, it’s essential to be aware of the criteria required for coverage.

  • The plastic surgery procedure must be medically necessary.
  • The procedure must aim to improve your overall health instead of only addressing your cosmetic concerns.
Pre-Authorization Requirements

Before undergoing any plastic surgery, it’s crucial to contact your insurance provider to determine whether your policy covers the procedure.

  • A detailed description of the procedure recommended by your physician.
  • Your medical history, including any pre-existing health conditions.
  • Your current medications and dosages.

It’s important to note that pre-authorization does not guarantee insurance coverage. If your plastic surgery procedure is for cosmetic reasons only, pre-authorization will not lead to coverage.

Cosmetic Vs. Medical Necessity

It’s vital to understand the distinction between procedures that are medically necessary versus cosmetic.

While both procedures may aim to enhance your physical appearance, cosmetic procedures are elective and not deemed medically necessary.

On the other hand, here are some examples of plastic surgery procedures that may be deemed medically necessary:

  • Reconstructive surgery after an injury or illness
  • Breast reduction to alleviate back pain
  • Skin grafts after severe burns

Check if your health insurance covers plastic surgery complications:

  1. Ensure the procedure is medically necessary, not cosmetic.
  2. Seek pre-authorization from your insurer to know your policy’s coverage.

Filing A Health Insurance Claim

How To File A Claim For Plastic Surgery Complications

Get coverage for plastic surgery complications with these steps:

  1. Gather medical records showing the procedure’s necessity.
  2. Confirm your insurer covers these complications.
  3. Use an in-network surgeon.
  4. Submit a claim within your policy’s time frame.
  5. Expect questions about your medical history and prior complications.
Tips For A Successful Claim

Filing a health insurance claim for plastic surgery coverage can be a complicated process, but there are several things you can do to increase the chances of success.

  • Choose a reputable plastic surgeon and perform thorough research on their medical history before committing to the surgery.
  • Speak to your health insurance provider in advance to obtain information on coverage for plastic surgery complications and to ensure that your procedure is in line with their policies.
  • Get a second opinion from another plastic surgeon or expert in the field.
  • Provide all the necessary medical records, including photographs of the affected area before and after the procedure.
  • Be persistent and communicate with your insurance company regularly.
Common Reasons For Claim Denial

Your health insurance claim for plastic surgery complications could be denied for various reasons:

  1. Lack of medical necessity: If the procedure isn’t medically necessary, it may not be covered.
  2. Out-of-network providers: Using an out-of-network surgeon could result in full cost responsibility.
  3. Poor documentation: Insufficient medical records, including proof of necessity, might lead to denial.
  4. Pre-existing conditions: If complications relate to a pre-existing condition, coverage may be denied.

Carefully document and follow guidelines to improve claim success, but be aware of these common denial reasons and address them accordingly.

Alternatives To Health Insurance Coverage

Plastic surgery can be a life-changing decision for many people. However, like any surgical procedure, it comes with its risks, including possible complications. A common question that arises when discussing plastic surgery is whether health insurance covers complications that may arise from the surgery.

In many cases, the answer is no. We will take a look at the alternatives to health insurance coverage for complications from plastic surgery.

Financing Options For Plastic Surgery Complications

Plastic surgery can be expensive, and complications resulting from the procedure can add even more to the cost. For those who may not have insurance coverage for such complications, there are financing options available to help manage the expenses.

Here are some financing options to consider:

  • Personal loans: A personal loan can be used to pay for the cost of plastic surgery complications.
  • Credit cards: In some cases, credit cards can be used to pay for plastic surgery complications. However, it’s essential to be cautious of the high-interest rates that come with using credit cards for this purpose.
  • Payment plans: Some plastic surgeons may offer payment plans to help patients manage the cost of complications resulting from plastic surgery.

Medicaid Waivers

Medicaid offers health insurance for low-income individuals.

It may cover plastic surgery complications if medically necessary.

If you lack Medicaid coverage, consider Medicaid waivers for additional medical expenses.

Scholarships And Grants

Non-profit organizations offer aid for plastic surgery-related costs, including complications:

  1. The Plastic Surgery Foundation: Provides grants for those unable to afford plastic surgery complication expenses.
  2. The National Breast Cancer Foundation: Offers financial assistance for breast reconstruction surgery, including related complications.

Health insurance may not cover all plastic surgery complications, but there are financing options like personal loans, credit cards, and payment plans. Medicaid waivers and non-profits can also provide financial help.


Health insurance coverage for plastic surgery complications varies by policy. Review and discuss your coverage with your provider before the procedure. Some policies cover complications, while others may not. Ensure you’re well-informed and consider the risks before deciding on plastic surgery. Discuss your options with your health insurance provider.

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