INSURANCE MATTERS MATTER
When is an operation considered “reconstructive?” When is it “cosmetic?'” Who decides? Who cares? policies uniformly do not cover cosmetic surgery, while they usually cover reconstructive surgery, so the disitiction is important. From the point of view of the plastic surgeon, are constructive
operation is one that has as its goal the restoration to normal of a part of the body that has been deformed through injury, disease, or it’s treatment, or birth defects. A cosmetic operation is one that attempts to improve upon that which is already normal. In both cases,”normal” is what the average person thinks. For example breast reconstruction after mastectomy is a reconstructive operation; breast augmentation is cosmetic. Some insurance companies use as a criterion the restoration of function. This is a poor yardstick. The breast no longer has a biologic function after child bearing has ceased, but women normally have two breasts, functional or not. Some insurance companies exclude reconstructive surgery if the person was insured under a different insurance policy at the time of the original accident or illness. This is an especially difficult problem for people whose work causes them to change jobs and thus insurance carriers frequently, but even long term company loyalist may find that their employer has changed insurance carriers. Everyone should be familiar with his or her health insurance policy. The time to read the fine print is before you need the benefits.
For any questions on any topic in plastic sutgery, call me at 523-6554.
We are located at 780 South Walnut.
Office hours are Monday through Friday by appointment. All reconstructive procedures are performed.