Cosmetic and elective treatments aren’t cheap, so wouldn’t it be nice if insurance covered the cost for you?
It’s few and far between, but there are some cases in which doctors can identify a legitimate medical problem. If so, you may be able to approach your insurance with a medical need that obligates them to chip in.
Here are five procedures that insurance may cover, along with what they will and won’t pay for.
Average cost: $6,275
Will cover: Insurance tends to cover septoplasty for patients with a deviated septum that is disrupting their breathing as long the problem is documented by a doctor.
Won’t cover: Any aesthetic changes to the nose, aka rhinoplasty, are not covered. “Many patients still pursue both procedures simultaneously, and doctors bill the septoplasty to insurance and the cosmetic portion to the patient,” says Dr. William Portuese, a Seattle facial plastic surgeon. The average rhinoplasty will set you back about $7,475, according to prices reported on RealSelf.
Average cost: $7,225
Will cover: “Many insurance companies will cover the procedure, but they don’t make it easy,” says Dr. Christopher L. Hess, a plastic surgeon in Fairfax, Virginia. Often, patients must visit their primary care doctors to establish back, neck or shoulder pain and try physical therapy first.
Won’t cover: Small downsizes will not be taken seriously. “About a pound of tissue from each breast must be removed for insurance to consider it necessary,” says Dr. Richard P. Rand, a Seattle plastic surgeon.
Average cost: $9,700 to $22,475, depending on treatment
Will cover “Insurance companies pay for many morbidly obese patients to have gastric bypass surgery, though this approval typically follows a psych evaluation and year of supervised diet and exercise,” says Dr. Mark Pleatman, a Bloomfield Hills, Michigan, plastic surgeon.
Average cost: $4,650
Will cover: “If the droopy skin around your eyes is interfering with your sight, insurance will often cover the procedure, provided tests show it will improve your vision,” says Dr. Kami K. Parsa, a Beverly Hills oculoplastic surgeon.
Won’t cover: “Insurance companies never cover the lower eyelid blepharoplasty,” he added.
Average cost: $4,975
Will cover: “Dental insurance policies that have an orthodontic benefit provide coverage without limiting it to a specific type of braces,” says Dr. R. William McNeill, a Mercer Island, Washington, orthodontist.
Won’t cover: Atlanta orthodontist Dr. Doug Depew says that insurance companies reimburse about half the cost when it comes to orthodontics. Be aware that you will still be expected to chip in a lot of money for the cost of your dental treatment.
Think you might be a candidate for a cosmetic procedure covered by insurance? Talk to a doctor.