One of the most common questions many patients ask before scheduling cosmetic surgery is whether their procedure is covered by insurance. In general, the answer is often “no”; however, many procedures typically considered cosmetic can, under certain circumstances, qualify for insurance coverage. The determining factor is whether the surgery is deemed medically necessary—meaning it’s essential for a patient’s health, function, or quality of life rather than performed purely for aesthetic purposes. In this blog, we’ll explore the plastic surgery procedures offered at Aesthetic Surgery Centre that may be covered by insurance, as well as the criteria that often determine eligibility.
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Generally, insurance companies do not cover elective surgery (cosmetic or otherwise). However, when an aesthetic procedure also corrects an abnormality, relieves pain, restores normal function, or treats a diagnosed condition, it can sometimes be reimbursed by insurance.
At Aesthetic Surgery Centre, our experienced surgeons and patient coordinators will help you navigate the often-overwhelming insurance approval process, working with your specific provider to determine whether your desired surgery meets their coverage requirements.
While the specific criteria for what is considered a medically necessary procedure can vary according to your insurance provider and individual insurance plan, in general, some of the documentation required may need to show that:
After losing significant weight, many people are left with loose, heavy folds of skin that can cause irritation, hygiene concerns, or restricted mobility. Post-weight-loss body contouring can help restore comfort and function while improving your confidence.
A body lift removes excess skin and fatty tissue from your abdomen, thighs, and buttocks to tighten and reshape your lower body. It may be covered if redundant skin causes chronic rashes, infections, or limits your mobility.
Also known as an arm lift, brachioplasty removes hanging skin along your upper arms. Insurance may cover this procedure when excess skin leads to skin irritation, chafing, or hygiene issues.
A thigh lift tightens and reshapes your thighs by removing sagging skin and fat. Insurance may approve coverage if skin folds cause chronic irritation or interfere with walking and physical activity.
A panniculectomy removes the “apron” of skin and fat (known as the pannus) that hangs below your abdomen. Panniculectomy surgery is frequently covered by insurance when the pannus causes recurrent infections, skin breakdown, or back pain.
While liposuction is usually considered a cosmetic procedure, it may be covered if it treats lipedema (a disorder characterized by the abnormal buildup of painful fat in the lower body) or removes lipomas (benign fatty tumors) that cause pain, discomfort, or decreased mobility.
Labiaplasty surgery is used to trim and reshape enlarged or asymmetrical labia. It may be considered medically necessary if excess labial tissue causes pain, hygiene issues, or discomfort.
In rare cases, breast augmentation may be covered when it corrects severe asymmetry or congenital abnormalities (such as tuberous breasts) that impact your self-esteem and body symmetry.
Insurance may cover breast implant removal if it’s necessary to address implant failure (rupture or leak), capsular contracture, infection, or if the implant interferes with accurate breast cancer imaging.
While often done solely for cosmetic reasons, a breast lift may qualify for insurance coverage if sagging causes chronic skin irritation or interferes with your posture and range of movement.
A breast reduction removes excess breast tissue to relieve neck, back, and shoulder pain, improve your posture, and reduce rashes or chronic irritation beneath your breasts—making it one of the most commonly covered breast surgeries.
Also known as male breast reduction, this procedure treats gynecomastia, which is the enlargement of male breast tissue, and may be covered when it causes pain, tenderness, or emotional distress. A confirmed diagnosis of the condition is also required.
Under the Women’s Health and Cancer Rights Act (WHCRA) of 1998, insurance companies that cover mastectomy procedures are also required to cover breast reconstruction, symmetry procedures, prostheses, and treatment of complications.
This procedure recreates your nipple and areola after mastectomy, often as the final stage of your breast reconstruction. It is typically included in WHCRA coverage.
Gender-affirming procedures are recognized by most major insurance providers as medically necessary for treating gender dysphoria. In order to be covered by insurance, you are usually required to provide documentation from qualified healthcare professionals confirming that you suffer from persistent gender dysphoria and that you have a history of living in alignment with your gender identity. Gender-affirming surgeries help ensure that your physical characteristics align with your gender identity and support your overall emotional and psychological well-being, which is why they are considered medically necessary.
Blepharoplasty, or eyelid surgery, removes excess skin and fat from your upper or lower eyelids (or both). Though it’s often performed for cosmetic reasons, upper eyelid blepharoplasty may be covered by insurance if sagging skin obstructs your vision, interferes with daily activities, or contributes to issues such as eye strain and headaches. Insurance approval typically requires visual field testing and documentation from an eye care professional confirming the impairment.
Cheek or chin augmentation involves restoring or improving your facial contours using implants, fat transfer, or other techniques. While cosmetic facial augmentation is typically considered elective, cheek or chin augmentation may be covered when performed to correct congenital abnormalities, to restore your facial shape after trauma, or to address aesthetic facial concerns following tumor removal or other reconstructive surgeries.
Earlobe repair or closure is performed to correct torn, stretched, or split earlobes caused by trauma, injury, or heavy earrings or gauges. When the damage results from an accident or medical condition (such as keloid scar formation or tissue necrosis), insurance may cover the cost of repair or reconstruction.
Otoplasty, or ear reshaping surgery, is used to correct protruding, asymmetrical, or deformed ears. While cosmetic otoplasty is elective, the surgery may be covered if it corrects congenital ear malformations, trauma-related abnormalities, or structural issues that affect your hearing or your ability to wear hearing aids.
Rhinoplasty, or nose surgery, is used to reshape the internal or external structure of your nose. Insurance may cover rhinoplasty when it corrects nasal obstructions that cause breathing difficulties, chronic sinus infections, or sleep disturbances, or when it repairs trauma-related malformations, such as a fracture or a deviated septum. While aesthetic refinements to your nose can be performed in conjunction with functional corrections, they are not typically covered by insurance.
Craniofacial procedures are performed to address abnormalities of the skull, face, or jaw caused by congenital malformations, trauma, or tumor removal. Craniofacial surgeries are almost always considered reconstructive and therefore medically necessary, as they restore both appearance and essential functions, such as breathing, chewing, and speech.
Keloid scars are raised, thickened areas of skin that can cause pain, itching, or even restrict your movement. Surgical removal or revision may be covered by insurance if keloids lead to physical discomfort, recurring infections, or functional limitations.
Mohs surgery is a specialized, layer-by-layer technique used to remove skin cancer while still preserving as much healthy tissue as possible. Because the procedure can aesthetically impact your appearance and function, reconstructive plastic surgery is often needed. Reconstruction following Mohs surgery can be considered medically necessary and can be covered by insurance.
The reconstructive surgeons at Aesthetic Surgery Centre are highly skilled in repairing delicate and visible areas of both your face and body following Mohs cancer removal, ensuring natural-looking results and functional restoration.
At Aesthetic Surgery Centre, although we perform a wide variety of procedures that may be covered by insurance, it’s up to you to bring as much information as possible to your consultation. Determining whether your plastic surgery will be covered by insurance starts with understanding the reason for your procedure. If it’s intended to correct a medical or functional issue, such as impaired breathing, chronic rashes, pain, or reconstructive needs after trauma or cancer, there’s a good chance it may qualify. If you feel that you can prove that the procedure is medically necessary, your first step should be to contact your insurance company directly to confirm your benefits and understand what documentation they require for coverage.
When you schedule your consultation at Aesthetic Surgery Centre, please come prepared by bringing documentation that supports your claim that the procedure you wish to undergo is medically necessary. You must have a referral or letter from your primary care physician or specialist confirming the diagnosis of the condition and recommending surgical treatment. Or, if you don’t have a referral, previous medical records (which may include diagnoses, imaging studies, pathology reports, photos, or notes from prior treatments) that demonstrate ongoing symptoms or the failure of more conservative treatment options are also acceptable. Without this initial documentation, we cannot proceed to the next phase of your treatment.
Having as much information as possible ready to present at your consultation allows our surgical and billing teams to submit a comprehensive pre-authorization request to your insurance provider, which significantly increases your chances of approval and minimizes delays in your treatment process.
Cosmetic surgery can be an important investment in your confidence and self-image, so cost shouldn’t stand in the way of looking and feeling your best. If your plastic surgery procedure isn’t covered by insurance, Aesthetic Surgery Centre offers several financing options. Finance plans through Cherry Financing, PatientFi, CareCredit®, and Alphaeon® Credit can make it easier to move forward with your aesthetic goals in a way that makes sense for your budget.
During your consultation, our team can walk you through each option, answer your questions about eligibility and terms, and help you find the financing plan that best fits your budget. From the subtle enhancement of laser resurfacing to the full-body transformation of a Mommy Makeover, choosing to finance your cosmetic procedure ensures that you can achieve the cosmetic results you desire without breaking the bank.
Whether you’re seeking skin removal after weight loss, a medically necessary breast procedure, or reconstruction following skin cancer removal, the team at Aesthetic Surgery Centre & MedSpa will guide you through every step. We’re committed to helping you navigate the entire process, from consultation and documentation to insurance pre-authorization, making your plastic surgery journey as seamless as possible. To schedule a consultation with one of our board-certified plastic surgeons, call us today at (253) 627-2900 or complete the online contact form.
