Can I use insurance for plastic surgery?

Knowing whether a procedure is cosmetic or reconstructive is crucial when it comes to plastic surgery, and insurance coverage can play a significant role in your choice. Many people would want to fix a functional problem, while others might be considering an aesthetic improvement. Dr. Azouz is a board-certified plastic and reconstructive surgeon in Dallas who aims to provide accessible and affordable care for his patients. Although both reconstructive and cosmetic surgery are under the same specialty, their functions are extremely distinct. The most significant factor for many patients is that different insurance companies have different approaches to them, including standard practices and how they decide what is covered.

What Is Reconstructive Surgery?

In order to restore normal function or appearance following an injury, illness, or congenital deformity, reconstructive surgery is performed. Since these operations are frequently considered medically necessary, insurance may cover them, particularly if specific medical requirements are satisfied. Some insurance companies include BCBS, United Healthcare, and Aetna. Dr. David Azouz is in-network with Cigna.

Common Examples of Reconstructive Surgery:

• Lipedema: Pain, swelling, and limited mobility are symptoms of a chronic illness that is frequently observed in women and is caused by atypical fat deposits. Fat nodules harden with time and alter vascular and lymphatic flow. If conservative measures like diet and compression therapy have been tried for several months without success, insurance may cover lipedema surgery.
• Functional Rhinoplasty: Functional rhinoplasty treats nasal blockages or breathing issues, as opposed to cosmetic nose jobs. A deviated septum can be corrected with a septoplasty to increase airflow. Patients frequently require verification of persistent nasal blockage, unsuccessful medical treatment (such as nasal sprays), and evidence of functional impairment in order for their insurer to pay them.



• Breast reduction: More than just a cosmetic procedure, breast reduction can help with skin rashes, posture problems, and persistent shoulder, neck, and back pain. Documentation of physical problems, the failure of conservative treatment (such as physical therapy), and the removal of a specific amount of breast tissue are typically requirements of insurers.
• Breast Reconstruction: Following a preventative mastectomy or therapy for breast cancer, a breast reconstruction can be performed. The specific procedure can vary depending on each patient.
• Skin Grafts for Burns: In order to encourage healing and avoid infection, it is frequently urgent and medically required. Thus, insurance may cover treatment.
• Hand Surgery: Hand surgery (e.g., for Carpal Tunnel Syndrome or Nerve Injury) is carried out to reduce nerve compression or to restore hand function and movement. Documentation of the condition’s functional impairment and unsuccessful non-surgical therapy is necessary for coverage.
• Facial Reconstruction: For patients with congenital defects (such as cleft palate), orbital injuries, nose injuries, or trauma. When function or vital appearance is compromised, insurers usually provide coverage.
• Hidradenitis Suppurativa: Surgical management for hidradenitis suppurativa, a persistent inflammatory skin disease that causes painful abscesses and scars. Following the failure of medication, antibiotics, and drainage techniques, surgery may be covered.

In most cases, insurance coverage for reconstructive surgery requires:

• A confirmed diagnosis
• Documentation of medical necessity
• Evidence of conservative treatment failure (e.g., physical therapy, medications, etc.)
• Photographs and surgeon’s notes
• Preauthorization from the insurer

What Is Cosmetic Surgery?

Cosmetic surgery is an elective procedure used to improve proportion, symmetry, or aesthetics. These operations are typically not covered by insurance and are not performed to address medical conditions or restore function.

Common Examples of Cosmetic Surgery:

• Rhinoplasty: By reshaping the nose to suit personal aesthetic preferences, including smoothing out the tip or eliminating a bump. Not covered unless a functional problem, such as breathing difficulties, is documented.
• Breast Augmentation: Corrects asymmetry or increases breast size. Unless it is a component of reconstruction after mastectomy, it is regarded as elective.
• Facelifts: Reduce wrinkles, tighten skin, and rejuvenate appearance. Always elective and not reimbursed by insurance.
• Gynecomastia surgery: Many insurance companies consider manboob removal surgery a cosmetic procedure and may refuse to cover it unless there is adequate medical justification.

What About Procedures That Fall in the Middle?

Sometimes the distinction between reconstructive and cosmetic surgery is unclear. Strong documentation is needed for these “hybrid” operations for insurance to reimburse them.

Examples include:

• Blepharoplasty – May be covered if vision is impaired.
• Panniculectomy – Removal of an overhanging abdominal “apron” may be covered if it is causing infections or hygiene issues.
• Rhinoplasty – Can be covered only when combined with functional correction (like septoplasty).

More Than Just Looks—It’s About Coverage, Confidence, and Care

Knowing the distinction between cosmetic and reconstructive surgery is more than just vocabulary; it can have a direct effect on whether your procedure is reimbursed by insurance. If certain requirements are satisfied, such as a documented diagnosis, evidence of symptoms, and unsuccessful conservative therapy, reconstructive procedures may qualify for insurance coverage and are frequently seen as medically essential. Even though they are frequently empowering and life-changing, cosmetic operations are usually not covered because they are elective and unrelated to a medical problem. It might be very difficult to navigate insurance requirements, but you don’t have to do it by yourself.

Choosing the Right Plastic Surgeon: With Insurance in Mind

Working with a plastic surgeon who is knowledgeable about the insurance process, in addition to your goals, is crucial when arranging your surgery.

At Azouz Plastic and Cosmetic Surgery, our staff are here to:

• Assist you in figuring out whether your insurance will cover your procedure.
• Help with gathering recommendations, photos, and medical records.
• Whenever necessary, submit requests for prior authorization.
• If your surgery isn’t covered, provide financing advice.

Are you prepared to begin? With complete assistance on the insurance and medical fronts, schedule a consultation with Dr. Azouz to learn more about your options. Trusted advice is the first step on your path to feeling your best. Contact us online or call us at (972) 702-8888. Virtual consultations are also available.

Written by Shahd Mansour and Rhiya Patel on behalf of Azouz Plastic and Cosmetic Surgery