Plastic Surgery - What is Covered by Insurance?
By Dr. Robert J. Davis, M.D.

The guys at the insurance companies are probably not going to like this article. That is because every day one of the first questions asked during an office visit is, “Will my insurance company cover this procedure?” We all pay a lot of money for health insurance, so if certain procedures are covered by your insurance plan, then it is your right to take advantage of this coverage.

Let’s start with the procedures that are not covered by health insurance. Your insurance company is not going to pay for your liposuction, your facelift, your breast enlargement or Botox. Plastic surgeons have an ethical responsibility not to report cosmetic surgery to the insurance company as if it were a reconstructive procedure.
There are, however, a lot of reasonable procedures that most insurance companies do cover. Your physician may have to write a letter, take photographs, or perhaps make a second appeal to present your case to the insurance company in order to have certain procedures approved.

For kids and teens: Correction of Prominent Ears is now considered a form of birth defect. Disfiguring acne scars are treated with dermabrasion. The correction of uneven or misshapen breasts (breast assymetry) in teenage girls is usually a covered benefit.
Many women do not realize that breast reduction is available from most insurance companies as long as the surgeon can state that the large size of the breasts is responsible for her neck, back or shoulder pain, creates grooves in her shoulders from the pressure of her bra straps, or causes her to have a heat rash under the breasts. All surgery associated with breast reconstruction after cancer treatment including any alterations in the opposite breast to make them symmetric is covered.

Seniors are often surprised to find out that the treatment of their baggy upper eyelids can be paid for by their health plan, including Medicare. An eyelid tuck or blepharoplasty is covered if a compromise in the visual field can be demonstrated. Your eye doctor can perform a simple test to prove that the baggy skin covering your upper eyelids is restricting your upper visual fields.

Changing moles are removed because of the possibility of melanoma, a potentially deadly form of skin cancer. Insurance companies recognize this fact and do not consider the removal of changing moles as cosmetic surgery.

MAGGIE’S MEMO:
ROBERT J. DAVIS, M.D., is a Board Certified Member of the American Society of Plastic and Reconstructive Surgeons. in private practice on the Eastern Shore for more than 17 years, he specializes in facial, hand and breast surgery. DR. DAVIS is a member of the Division of Plastic Surgery at Peninsula Regional Medical Center and Chief of the Medical Staff of Atlantic General Hospital.

MAGGIE SAYS:
We found DR. ROBERT J. DAVIS to be exactly what we needed and looked for in a doctor. Thoroughly professional and extremely knowledgeable, his manner with patients puts them at ease and forges trust. DR. DAVIS evidences a respect for his patients and helps them acquire the information they need to make the decisions that are best for each. Call on him with confidence.