Did You Know: Insurance May Cover Plastic Surgery Procedures Such as Female and Male Breast Reduction, Post-Weight Loss Tummy Tucks, Septoplasty, and More?

Insurance coverage is somewhat rare in plastic surgery, as the majority of procedures are deemed elective by insurance carriers. ⁽¹⁾ However, many patients miss the opportunity to involve insurance coverage in their payments because they assume it will not be applicable, but this is not always the case.

The award-winning team at Greenberg Cosmetic Surgery and Dermatology has expertise in navigating the confusing and frustrating world of insurance policies. We are here to help you investigate your insurance payment options; simply call us at (844) 484-0123 to set up your complimentary insurance verification consultation in any of our offices including;

We encourage all potential patients to schedule a complimentary insurance verification consultation to find out more about insurance coverage for their plastic surgery procedure. Whether insurance will cover your costs or not, we believe that happiness is one of the most important factors in a person’s overall health, and if one of the procedures we offer will help you achieve that, then do not hesitate to plan a personalized treatment.

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Insurance Coverage for Plastic Surgery

Plastic surgery is broadly categorized into two types: reconstructive and cosmetic. Reconstructive surgery is often considered medically necessary and in many cases is covered by health insurance plans. Procedures such as breast reconstruction after mastectomy, repair of severe burns, or corrections of congenital defects often fall under this category. In contrast, purely aesthetic surgeries aimed at enhancing appearance, like facelifts or breast augmentations, usually do not qualify for insurance coverage as they are deemed elective.

Our main goal in any cosmetic procedure is to bring you happiness while improving your health and ensuring safe, effective treatments and long-lasting results. Many studies have shown that large out-of-pocket procedure expenses have a direct correlation with treatment non-adherence and increased, worsened complications in a patient’s recovery. ⁽¹⁾ We seek to minimize this as much as possible. We also offer various financing plans for our patients. Even if you do receive insurance coverage, you can incorporate one of these to help pay for your procedure while benefiting from the results.

While insurance coverage may be difficult to navigate in plastic surgery, some common procedures will still qualify. Any procedure that is relevant to a patient’s overall health (in the eyes of the insurance companies) is likely to qualify. In this guide, we explain the procedures that may be covered by your insurance.

Female Breast Reduction

Also known as reduction mammoplasty, female breast reduction procedures help patients live happier, healthier lives by reducing the size of their breasts. Oversized breasts can emerge as a result of hormonal changes, weight gain, pregnancy, and more, and can affect women of all ages and backgrounds. Large breasts can be a serious medical concern for many patients. Carrying excess mass on your chest can lead to back, neck, and shoulder pain. Large breasts can also lower one’s sleep quality, create discomfort, and be a source of embarrassment and self-image issues. Many women will face frustration in dressing themselves and finding clothing and have to alter their activities and exercise to accommodate their breasts. Adolescent girls can also face these issues with a condition called giant virginal hypotrophy. In these cases, these health and psychological complications are often much worse. ⁽²⁾

Insurance coverage is very common in breast reduction procedures because of these associated health risks. Patients regularly experience significant pain in their bodies due to enlarged breasts, and if these are not treated, their health suffers over time. To show medical necessity, documentation of chronic pain or other health issues related to breast size will likely be required. Our experienced team submits the necessary paperwork on our patients’ behalf.

Male Breast Reduction

Male breast reduction procedures treat a condition called gynecomastia. Gynecomastia can occur during puberty or later in life. This condition can emerge from several different sources; including obesity and weight gain, medication use, hormonal changes, stress, and more. ⁽³⁾ The social and psychological stigmas of enlarged male breasts can have a heavy impact on men’s mental health.

Many men will retreat into social isolation, reduce their activity, and harbor serious self-image issues as a result of gynecomastia. ⁽³⁾ As such, many insurance companies will cover male breast reduction procedures. For those affected, male breast reduction surgery offers both emotional relief and an improved self-image. The level of coverage may depend on the severity of a patient’s condition, but most men will receive some form of coverage to help them achieve the results they require to improve their lives.

Tummy Tuck After Massive Weight Loss

As glucagon-like peptide-1 (GLP-1) receptor agonist medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Zepbound, Mounjaro) grow in popularity, increasing numbers of patients are losing massive amounts of weight in short periods. When rapid weight loss occurs, the skin is not always able to snap back to a tight, flush fit against the body. Obesity and weight gain can cause skin to lose its natural elasticity, and when fat is reduced, many patients are left with excess skin sagging from their former fat deposit sites. This sagging skin is embarrassing for many patients and can affect their self-esteem. It is also prone to hygiene issues as it collects sweat and dirt that is hard to clean. Depending on its location and size, it can also cause back, neck, shoulder, and knee pain in patients, and this sagging skin can make exercise, dressing, and other activities much more difficult, adding unnecessary frustration and embarrassment into patients’ lives.

Tummy tucks, known officially as abdominoplasties, correct this sagging skin by removing part of it to create a flat, toned appearance in the midsection. Our surgeons make an incision below the belly button near the underwear/bikini line. Once this is made, they will remove the excess dermal tissue and suture the incision. Once removed, sagging skin will be disposed of and the result is a smooth, flat abdomen, free of any loose, flappy skin. Conditions such as excessive skin leading to rashes, infections, or decreased quality of life may support claims for insurance reimbursement.

Septoplasty

Nasal septoplasty is one of the most commonly performed procedures in facial plastic surgery. Its main focus is to correct the septum (the wall of bone and cartilage that separates the nasal cavities) and enhance a patient’s ability to breathe. ⁽⁴⁾ Septoplasty is almost always covered by insurance to some degree because it is primarily a functional procedure, not a cosmetic one. ⁽⁴⁾Some septoplasty procedures may include an added rhinoplasty; if this is the case, then insurance coverage may only be partial. Any procedure that corrects or alters the nose is highly specific to each patient because each nose and each face is unique. As such, pricing for each procedure will be different for each patient.

Common indications for a septoplasty are a deviated septum that creates an angled or shifted nose point or obstructs the airway and hinders breathing. Our rhinoplasty specialists will examine your nose and septum from all angles to determine what the best course of action will be. Once your procedure is planned, your septum will be corrected to optimize airflow, as well as give you a nasal appearance you are proud of.

Breast Reconstruction

While breast reconstruction procedures can incorporate methods from cosmetic breast augmentation like fat transfers, implants, and more, the key difference is that reconstruction normally follows mastectomy, whether unilateral (one breast) or bilateral (both breasts). Many breast cancer patients face mental health and body image issues, and reconstructing the breasts often gives them a renewed sense of beauty and womanhood. ⁽⁵⁾ Federal law mandates that insurance must cover any breast reconstruction (and any revisional procedures) for any patient who undergoes these treatments following a cancer-related procedure. ⁽⁶⁾

Cost of Breast Reduction on Long Island

The world of insurance coverage for plastic surgery can be overwhelming, but we are here to help you navigate it.

Regardless of whether you think you will receive insurance coverage or not, we encourage you to schedule a complimentary insurance verification consultation at Greenberg Cosmetic Surgery and Dermatology to learn more about the benefits of receiving the procedures you require.

FAQ

References

1. Billig JI, Chen JS, Lu YT, Chung KC, Sears ED. The Economic Burden of Out-of-Pocket Expenses for Plastic Surgery Procedures. Plastic & Reconstructive Surgery. 2020;145(6):1541-1551. doi:https://doi.org/10.1097/prs.0000000000006847
2. Purohit S. Reduction mammoplasty. Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India. 2008;41(Suppl):S64-S79. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2825129/
3. Vandeven HA, Pensler JM. Gynecomastia. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK430812/
4. Watters C, Brar S, Yapa S. Septoplasty. PubMed. Published 2021. https://www.ncbi.nlm.nih.gov/books/NBK567718/
5. Regan JP, Casaubon JT. Breast Reconstruction. PubMed. Published 2022. https://www.ncbi.nlm.nih.gov/books/NBK470317/
6. Women’s Health and Cancer Rights Act (WHCRA) | CMS. Cms.gov. Published 2013. https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/whcra_factsheet