What is the difference between cosmetic and reconstructive surgery? I have had difficulty with my insurance calling things cosmetic which I do not think are really cosmetic.
Answer from Dr. Kremer:
Cosmetic surgery is performed to reshape “normal” structures in order to improve the patient’s appearance. Cosmetic surgery is not covered by health insurance.
Reconstructive surgery is performed on “abnormal” structures of the body caused by congenital defects, developmental abnormalities, trauma, defects following surgical treatment of cancer, or other diseases or difficult wounds. It is often performed to improve function but many of these operations are also done to improve appearances as well. Reconstructive surgery is usually covered by most health insurance plans, although coverage for specific procedures and the amount of coverage for these procedures varies greatly between health plans. Accident insurance policies often cover the treatment costs for "cosmetic" surgery after trauma.
There are several common operations performed in plastic surgery that are increasingly difficult to get covered by insurance plans. Breast reduction is one of these operations. Other procedures, such as surgery to correct congenitally abnormal ears, remove keloids or widened scars, or scar revisions are additional procedures that are difficult at times to get covered by insurance plans.
Please contact your insurance carrier early ahead of time. Our office will assist you in explaining your individual situation to your health or accident insurance, if necessary by a detailed assessment and photo documentation. Eventually, at least a partial coverage agreement can be negotiated.