Plastic surgery encompasses both cosmetic and reconstructive surgery.
Cosmetic surgery is performed to reshape normal structures of the body in order to improve the patient’s appearance and self-esteem. Cosmetic surgery is usually not covered by health insurance because it is elective.
Reconstructive surgery is performed on abnormal structures of the body, caused by congenital defects, developmental abnormalities, trauma, infection, tumors or disease. It is generally performed to improve functions, but may also be done to approximate a normal appearance. Reconstructive surgery is generally covered by most health insurance policies, although coverage for specific procedures and levels of coverage may vary greatly.
There are a number of “gray areas” in coverage for plastic surgery that sometimes require special consideration by an insurance carrier. These areas usually involve surgical operations which may be reconstructive or cosmetic, depending on each patient’s situation. For example, eyelid surgery (blepharoplasty) – a procedure normally performed to achieve cosmetic improvement – may be covered if the eyelids are drooping severely and obscuring a patient’s vision.