However, if the surgery is needed to fix a deformity caused by injury, illness, or birth conditions, insurance may cover it. The key factor is whether the surgery is seen as necessary for medical reasons or if it’s purely for looks.
Does Insurance Cover Plastic Surgery After Skin Cancer?
This type of reconstructive surgery is usually medically necessary, rather than cosmetic, to restore appearance and function after surgical procedures to remove skin cancer. The extent of coverage would depend on the patient’s specific health insurance plan and the type of reconstructive procedures needed.
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Fighting Denied Claims for Reconstructive Surgeries
Even when plastic surgery is medically necessary, getting your insurance provider to cover the costs can be challenging.
Reconstructive procedures aim to restore form and function from incidents like illnesses, accidents, or congenital issues. Though not performed just for cosmetic reasons, claims still face routine denials.
If your reconstructive surgery claim gets denied, don’t panic. There are options to appeal, especially with your doctor as an ally explaining why the procedure is essential. Craft an appeal letter highlighting aspects like future disability without treatment, inability to perform daily tasks, or severe psychological burdens. Provide all details backing your case.
If initial appeals fail, consider hiring a lawyer well-versed in insurance policies and health law. They can add legal weight when renegotiating with providers, explore alternate coverage potentials, or even take legal action in extreme cases.
Even if ultimately unsuccessful in fighting your insurance company, discussing payment plans or discounted options with your care provider could aid affordability.
Do Any States Require Coverage for Plastic Surgeries?
Requirements around insurance coverage for plastic surgery procedures vary extremely between states. Only around 20 states offer protections requiring coverage for reconstructive operations, with criteria focusing on restoring function from illness, trauma, or birth defects.
For example, New Jersey laws dictate that any medically necessary procedure must be covered, including plastic surgeries for injury victims. Indiana expanded regulations to implant breast reconstruction after mastectomy. California passed expansive laws requiring insurance policies to include reconstructive surgery for congenital abnormalities.
Compare your state’s specific regulations around reconstructive and plastic surgery coverage requirements using online resources. Identify if protections exist for your unique situation before pursuing appeals or alternative funding options for procedures deemed medically essential by your provider.
When Plastic Surgery is Medically Necessary
What transforms plastic surgery from a cosmetic choice into a medical necessity? Insurance companies determine coverage eligibility based on improving functionality affected by trauma, illness, or birth defects.
For trauma victims, reconstructive procedures aim to repair disfigurements from incidents like dog bites, burns, head injuries, or car accidents. After disease treatments like mastectomy due to breast cancer or marking removal for skin cancer, procedures restore physical appearance and capability. Surgeries can also correct severe congenital issues, like cleft palate repair enabling easier feeding/breathing.
In all cases, plastic surgeries covered by insurance must aid tangible physical or psychological issues stemming from medical events. Purely aesthetic enhancements without functionality improvements or psychological distress rationales will stay deemed cosmetic and ineligible by insurance providers. Distinguishing between the two is key for claim approval.