Do Insurance Companies Cover Plastic Surgery?

There are many health insurance companies that may pay for plastic surgery depending on the terms and conditions of the health insurance plan. Also, it should be kept in mind that health insurance companies cover plastic surgeries which are considered to be reconstructive and non-cosmetic.

When Does Insurance Company Cover For Plastic Surgery?

As mentioned earlier, health insurance companies may cover for plastic surgeries which are aimed to be reconstructive and not cosmetic. Therefore it is important to find out if the surgery is essential to preserve the quality of life in order to be covered by the health insurance plan. All insurance policies follow some guidelines and adhere to some definitions of what is considered to be reconstructive in order to cover it in case of a plastic surgery.

When is a Surgery Considered to Be Reconstructive?

Reconstructive surgery refers to a surgical procedure to be performed on abnormal body structures that may occur due to congenital defects, developmental abnormalities, trauma, infection, tumor or some kind of disease. The reconstructive surgery aims to improve the function and give the patient a normal appearance.

Is Breast Reconstruction Surgery Covered By Insurance Companies?

The Women's Health and Cancer Rights Act (WHCRA) allows the health insurance plans to cover the entire process of mastectomy along with the reconstruction surgery. This mandate applies to Health Maintenance Organizations (HMO), private health insurance companies and group health plans. The WHCRA stipulates the insurers to cover the following along with mastectomy-

  • Reconstruction surgery of the breast that was surgically removed as a part of the cancer treatment.
  • Reconstruction surgery of the remaining breast to create a balanced appearance.
  • The expenditure of breast implantation.
  • Further treatment for any form of physical complication due to mastectomy.

It must be remembered that like any other type of medical procedure, the patient may have to pay a deductable or co-insurance for breast reconstruction surgery.

What are the Precautions That One Should Be Aware Of In Breast Reconstruction Surgery?

Breast reconstruction surgery is a major operation and few important things are to be kept in mind while the recovery process is going on. They involve-

Support Groups: It may happen so that women might take some time to emotionally adjust once they have had their breasts reconstructed. It might take time to get used to the reconstructed breasts. Talking to other women who have gone through the same surgery might be beneficial. If need be, a mental health professional might be sought.

Regular Checkup: In case the patient has got silicone implants, regular MRI scans need to be done to ensure that they are not leaking. This is because leakage of silicone implants may occur without any possible symptoms.

Clothes: It is important to ask the doctor when to go back to wearing regular bras. It is also important to know and understand the type of bra that might be comfortable to wear. In most cases, underwired bra might be uncomfortable during the time of healing from the surgery.

Exercises & Activity: The surgeon should be consulted with respect to when to start with stretching exercises and normal activities. This is because different reconstruction surgeries require different precautionary techniques. It may be a basic rule to refrain from strenuous exercises, sexual activities and heavy activities for 4-6 weeks after the surgery.

Emergency: The doctor should be consulted immediately in case of observed swelling, limps or pain. The doctor should also be informed in case of leakage from breasts or armpits. In fact, any form of symptoms that the patient might notice should be informed to the doctor as soon as possible.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: December 8, 2017

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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