Health Insurance and Cosmetic Surgery

The chance of having cosmetic surgery through your private health insurance is unlikely because most cosmetic treatments are considered elective procedures. In most cases, insurance policies will only cover necessary medical procedures. Having said that, there are some instances when private health insurance providers may cover the cost of your cosmetic surgery.

When does health insurance policy include the coverage of cosmetic surgery?

Whether the cost of cosmetic surgery is covered by your health insurance or not really depends on a few of key factors. Who bears the cost of your procedure depends entirely on the insurance company you’re using and how the procedure you need is defined. It is important to assess the procedure you’re seeking to determine if the surgery is purely cosmetic, reconstructive, essential to body function or preserving the quality of life. This means, if the procedure you need is also medical, your health insurance policy may cover it.

If, for example, you have difficulty breathing because of the shape of your nose you may be entitled to nose surgery, or rhinoplasty, through your insurance policy. Additionally, women with overly large breast who are experiencing discomfort and severe pain in their back and should may be offered breast reduction surgery. Finally, certain weight loss procedures, as well as a tummy tuck, may also be available on some health insurance policies, if excessive weight is causing serious health problems.

The only way to be sure if your procedure is covered by your private health insurance policy is to contact your policy provider and discuss your situation with them first. They can advise you on the best way to move forward with your procedure. If the procedure you want isn’t covered, you can then think about other options that are available to you.

Which cosmetic Surgery is unlikely to be covered by health insurance?

It’s quite normal for anyone who has taken out health insurance to want all their medical expenses covered by their policy. Unfortunately, that is not how things work in reality. Cosmetic surgery, generally won’t be covered by most health insurance policies because they’re often elective procedures that are not usually considered as necessary to maintain quality of life or body function. In instances where a cosmetic procedure can provide improvements in health and quality of life, some policies may cover expenses, but this will need to be discussed with the insurer before having the treatment.

Here are some examples of treatments that are not usually covered by health insurance, however exceptions may be made in some cases.

  • Liposuction
  • Breast enlargement/ augmentation
  • Tummy tuck
  • Brow lift
  • Face lift
  • Male chest reduction
  • Hair transplant surgery
  • Eyelid surgery
  • Lip reduction

How to get cosmetic surgery using health insurance cover?

There are many health insurance policies that won’t cover cosmetic procedures, even if it’s for medical reasons. Before taking out your health policy, be sure to read the terms and conditions thoroughly to fully understand what is and isn’t covered.

If your health policy covers you, before you can go ahead with the surgery, you will need to speak to your GP or doctor and get a referral to a specialist. The specialist will take you through the procedure and discuss the options available. Once you have agreed on the treatment you will need to contact your insurer and provide any documentation they need to process your application.

Be sure to check exactly what part of the cost is covered by your health insurance policy. This will ensure you won’t encounter any unwanted surprises.

How is cosmetic surgery paid for through health insurance?

The payment process can vary depending on the hospital or clinic, and your insurer. In some cases, the hospital or clinic will invoice you for the treatment which you will then have to forward to your policy provider. In other cases, the insurer will be billed directly, so will require you to provide your reference number, scheme details, and pre-authorisation documents. To be safe, you should make sure you’re pre-approved by your insurer, meaning your claim has been process and the money is ready to be paid out. If there are any costs that are not covered by your policy, you will be expected to pick up the bill.

Checklist to make sure your cosmetic surgery is covered by health insurance

  1. Contact your health insurance company directly and find out what coverage you have for cosmetic surgery procedures
  2. Get a detailed estimate, with cost predictions for your surgery so you can review this against your policy coverage
  3. Find out what your excess would be in the event of coverage
  4. Find out what the maximum payable amount is, and if they expect you to pay a certain percentage of the procedure
  5. Find out what related medications like pain killers would be covered
  6. Get the details in writing of your coverage so you are not surprised. Never assume anything is covered unless your health insurance company confirms it.