insurance


Septoplasty insurance coverage might be possible provided that the patient and his doctor are able to prove that this type of nose surgery aims to improve breathing functions. For this reason, proper medical documentation is of critical importance.

 

While septoplasty is commonly combined with rhinoplasty, or more commonly referred to as nose job, its only aim is to improve the function of the nose—not its outside appearance or “aesthetics.”

 

septoplasty insurance coverage

Septoplasty primarily “aligns” the deviated septum, which is the strip or wall of tissue between the nostrils, ultimately eliminating the “obstruction” of airflow. In general, it has no or very little effect on the outside appearance of the nose, according to California Surgical Institute website.

 

Should the patient and his doctor are able to demonstrate that septoplasty is a medically warranted procedure, health insurance is possible. Many surgeons these days have well-trained staff who can verify insurance coverage and possibly help individuals secure proper medical documentations.

 

Nonetheless, septoplasty insurance coverage typically means that the patient will still pay for the deductibles, copays, etc.

 

It is not uncommon to combine septoplasty and rhinoplasty in one surgery. Should the insurance agree to cover the cost of the “reconstructive part” of the operation, the patient will still have to pay for the anesthesia “time” associated with the cosmetic aspect of the procedure.

 

It is almost always ideal to combine septoplasty and rhinoplasty (should the patient wish for cosmetic improvements as well) instead of performing them separately. With combo procedure, he will only experience recovery once and possibly lower the overall cost of the surgery.

 

Doing them together also gives the surgeon more “options” and better control over the aesthetic aspect of the nose. For instance, instead of throwing away the removed [excess] septal cartilage, which contributes to the abnormal airflow, he is able to re-use it to refine the tip and/or create a stronger structural support.

 

As of this writing, the average cost of septoplasty combined with rhinoplasty varies from $5,000 to $8,000.

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Body lift surgery insurance is becoming more and more difficult nowadays as companies are making their approval criteria highly stringent. But with proper medical documentation and recommendations from board-certified plastic surgeons and other experts, this might be a possibility.

 

More than a decade ago, body lift surgery insurance after massive weight loss was very common. But with the growing popularity of bariatric surgery—and the requests for body contouring surgery among MWL patients as well—companies took note of this trend and thus became more selective in their approval process.

 

body lift surgery insurance

Photo Credit: Ambro at FreeDigitalPhotos.net

As of this writing, most MWL patients can only expect insurance coverage with their breast reduction and panniculectomy, provided that they are able to present extensive medical documentations, according to California Surgical Institute website.

 

Meanwhile, body lifts such as tummy tuck, arm lift, bra back lift, breast lift, and thigh lift are rarely paid by insurance since they are now categorized as cosmetic procedures despite the fact that large redundant skin can lead to tissue breakdown, non-healing irritation, foul odor, poor hygiene, and back pain.

 

However, some insurance companies may cover the cost of 360 degrees body lift—i.e., removing the excess skin from the abdomen, hip-flank region, and back—if the redundant tissue is causing physical discomfort such as lower back pain and skin breakdown.

 

For insurance approval, companies need photos of the redundant skin and the problems associated with it such as non-healing rashes. Previous “attempts” of treating these conditions through non-surgical means—such as the use of creams or ointments—might also be helpful to build one’s case. Hence, receipts of these topical treatments must also be part of medical documentation.

 

Should the excess skin and fat along the waistline cause lower back pain, the patients must present recommendation letters from an orthopedic spine surgeon or neurosurgeon suggesting that removing the redundant tissue in the abdomen, buttocks, and hips can improve their quality of life.

 

In case that body lift surgery insurance is not feasible, the patients may consider other financing options such as medical or regular credit cards, home equity loans, bank loans, unsecured loans, and in-office financing. Nevertheless, it remains in their best interest to have available funds that are at least two times the actual cost of their surgery to protect them from “unfortunate” incidents such as longer-than-usual recovery or the need for revisions.

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Functional eyelid surgery removes the excess skin and/or corrects the abnormal position of the upper eyelid margin. The primary goal is to improve the peripheral view and to address irritation and other function-related issues.

 

While functional eyelid surgery could provide the same rejuvenating effects as the standard blepharoplasty, the latter is rarely covered by health insurance since its only goal is to improve the aesthetic features of the eyes.

functional eyelid surgery

Functional Eyelid Surgery Which Subsequently Provides Rejuvenating Effects. (Before and After Photos)

In general, most major insurance companies will cover the cost of functional eyelid surgery as long as the patients and their surgeons are able to demonstrate visual impairment, according to the California Surgical Institute website.

 

However, it is not uncommon for insurance issuers to be exceptionally strict—i.e., it may appear that they are skeptical of the medical necessity for an upper eyelid surgery—that could discourage some patients from seeking coverage despite having impaired vision.

 

Aside from documented photos of eyelid droop, insurance issuers also demand physical exams such as superior visual field test (with tape vs. without it). If the patient experiences improvement in her vision with a tape holding her drooping upper lid, then the surgery is considered as medically warranted.

 

While some upper eyelid surgeries are considered a non-cosmetic case, any procedure involving the lower eyelid is automatically categorized as an aesthetic procedure, thus insurance coverage will not apply.

 

Whether an upper eyelid surgery is performed for cosmetic reasons or functional improvement, a good surgeon will make every effort to place the incision within the existing or “new” eye crease so the resulting scar blends well with the surrounding skin.

 

To further achieve natural results and preserve the normal functions of the eyelid, it is important to remove just the right amount of excess skin and/or fat. All efforts must be done to avoid over-correction since it can lead to a wide range of complications, including retraction.

 

Eyelid retraction is characterized by the upward displacement of the upper eyelid (or downward shift in the case of lower eyelid) thus exposing more white part of the eye. Aside from its unnatural and unpleasant effect, the condition can lead to more problems such as dry eyes and irritation.

 

Knowing how much skin is removed vs. how much is preserved all boils down to a meticulous physical exam in which all key variables are taken into account such as the brow position, lid crease height and shape, and tightness of the ligaments and other supportive structures.

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Panniculectomy cost is oftentimes covered by health insurance, although the patient must be able to demonstrate that it is a medically necessary procedure, as opposed to a cosmetic surgery.

To get a pre-approval, the patient must present medical evidence and doctor’s recommendation letter suggesting that the hanging, apron-like skin is causing non-healing irritation, mobility issue, poor hygiene and foul odor, and/or back pain due to its extra weight.

panniculectomy cost

Board-certified plastic surgeons who focus on body lift after weight loss generally have staff who are familiar with the insurance process.

Should the patient’s claims are rejected, she can appeal and possibly provide additional medical proof suggesting that her panniculectomy is a reconstructive procedure in which the main goal is to improve her body function, as opposed to physical appearance.

According to California Surgical Institute website, the most common reasons for denials are lack of physical and lab tests, incomplete insurance information, and diagnosis error.

Insurance coverage is very helpful because the average panniculectomy cost is $8,000-$12,000. In some cases it covers the entire amount, although one survey has suggested that many patients-policyholders should expect at least $300-$500 out-of-pocket expenses.

Just like a tummy tuck, panniculectomy also uses a hip to hip incision to remove the apron-like hanging skin. However, there are key differences between the two procedures.

While both procedures results in a hip to hip scar, panniculectomy is primarily designed to remove a large flap of redundant skin and fat caused by massive weight loss. Tummy tuck, meanwhile, focuses on its cosmetic component: To create a slender waistline and flat abdomen.

Tummy tuck provides more contouring than panniculectomy because aside from removing the excess skin and fat, it also tightens the abdominal muscle that has been stretched due to pregnancy or weight loss.

But unlike panniculectomy, tummy tuck is generally categorized as a cosmetic surgery and therefore rarely covered by health insurance.

Sometimes, panniculectomy is combined with other procedures such as tummy tuck (for muscle repair) and liposuction (fat removal), leading to a more balanced appearance. However, the cosmetic components of the surgery will not be covered by health insurance.

While it is always ideal to have panniculectomy only when the patient has achieved her weight goal, sometimes it is performed even though more weight loss is expected if the redundant skin is causing a lot of discomfort.

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Gynecomastia surgery financing — Is it covered by insurance?

As of this writing most gynecomastia surgeries, or male breast reduction procedures, are not paid by insurance companies known for their strict and complicated requirements.

gynecomastia surgery financing

Photo credit: everydayplus at FreeDigitalPhotos.net

Even if the male breasts are excessively large, almost resembling that of a woman, in 99 percent of cases insurance companies will not pay for its cost even if the condition leads to a myriad of psychological issues including poor body image, low self-esteem, and anxiety.

From most insurance companies’ point of view, gynecomastia surgery is simply a cosmetic, elective condition, unless in some instances when abnormal enlargement of the male breast is caused by cancerous tumors and/or it is associated with extreme pain and sensitivity.

Some patients have abnormally large male breasts due to tumors growing along the tissue, while others experience significant pain and sensitivity problems. Because these factors have a detrimental effect on health and body functions, insurance issuers may pay for the surgery.

Sometimes, the condition is a side effect from certain cancer treatments. While some patients opt for later correction, “prompt” procedures such as liposuction, breast tissue excision, and/or pain control might be a viable option in certain situations.

But to achieve pre-approval from insurance companies, patients must provide extensive laboratory tests, physical check-ups, and recommendation letters from their plastic surgeons and/or specialists.

Aside from insurance, patients may consider other gynecomastia surgery financing options such as “plastic money,” medical credit cards, bank loans, doctor’s payment plans, and even home equity loans. Nevertheless, it remains ideal to achieve a certain level of financial stability prior to surgery.

Some “conservative” surgeons from Inland Empire plastic surgery even suggest having available funds twice the amount of the surgery’s cost to prepare for longer-than-usual downtime, hospital admission, and medical care should they experience postop complications.

Regular credit cards, or plastic money, are one of the most accessible financing options, with most Americans owning at least two cards. However, many surgeons pass on the surcharge or transaction fees, usually 2-3 percent, to their patients.

Medical credit cards are also a good financing option, with some of them providing reasonable interest rate and payment plans. And because they preclude binge shopping—since they are only exclusive for medical services—proponents suggest that they give people a good amount of control.

It is important to note that plastic surgery is not about “bargain hunting,” thus any doctor offering a price that is way lower than the average is generally considered a dubious practitioner.

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Plastic surgery insurance plans only apply to patients who need to improve their body functions, or address their congenital defects and deformities caused trauma or disease. Meanwhile, issuers rarely cover procedures in which the primary goal is to enhance one’s appearance.

But sometimes, insurance coverage applies to some plastic surgeries that are more known as a cosmetic procedure. For instance, breast implants for post-cancer patients who had mastectomy are considered medically warranted as they play a crucial part in women’s psychological health and body image.

plastic surgery insurance plans

Photo credit: renjith krishnan at FreeDigitalPhotos.net

Eyelid surgery, or more accurately referred to as blepharoplasty, is another popular cosmetic surgery that is occasionally treated as a reconstructive procedure, thus plastic surgery insurance might be a possibility. However, the patient and her surgeon should be able to prove that the excess upper lid skin interferes with her vision.

Also, insurance companies may pay for the cost of breast reduction surgery as long as the overlarge cup size is the underlying problem for the postural problems, chronic back and neck pain, hunched shoulders, and systemic discomfort.

In the past, plastic surgery after weight loss—such as lower body lift, extended tummy tuck, and arm lift—was covered by health insurance. But with the growing obesity problem that is prompting many people to undergo bariatric surgery, issuers have become stricter to the point that only a few patients are qualified.

As of this writing, panniculectomy is the only plastic surgery after weight loss that is “traditionally” covered by insurance. This procedure removes the apron-like skin in the abdomen, although it does not provide the same amount of contouring achieved after a tummy tuck in which the splayed muscle is also repaired, leading to a narrower waistline.

Meanwhile, experts at the California Surgical Institute provide some helpful tips to gain approval from insurance plans.

  • Consult board-certified plastic surgeons. Oftentimes, they have staff who are familiar with the insurance process and can assist patients from securing the requirements for pre-approval.

Recommendation letters and medical evidence (pictures and test results) from plastic surgeons, therapists, and other experts are also needed for insurance pre-approval.

  • Contact insurers in advance. Prudent patients must obtain all the pertinent information by contacting their insurance issuers and reading the “fine print” of their policy.
  • Make an appeal. Should their insurers deny coverage, patients have the right to

appeal the decision and possibly submit more evidence proving that their plastic surgery is medically warranted and not solely for cosmetic improvements.

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