When a Does Plastic Surgery Procedure will Be Covered By Insurance?


Your health insurance policy might actually pay for your plastic surgery depending on the policy of your plan. More often than not, this happens if the surgery is deemed non-cosmetic and reconstructive purposes. So for instance that you’ll be undergoing Brazilian butt lift Toronto to improve your physical appearance, sorry to tell you but you will have to pay it out of pocket.



As per the American Society of Plastic Surgeons, the plastic surgery industry is a multibillion dollar business raking in $13.5 billion just in 2015.

That comes out to tons of money in doctor fees. So the question now is, who’s paying for the high costs of plastic surgery? The answer will depend on various factors.

When Does a Plan Include Plastic Surgery Coverage?

The question of who is paying for the cost of plastic surgery depends on the type of health insurance and insurance company you have. Not to mention, how the entire procedure needed is defined. To help determine whether the procedure is covered, it’s important to figure out if:

  • The surgery is cosmetic
  • Reconstructive or
  • Essential to bodily functions or preserving quality of life

The answer to the postulated questions will dictate if the procedure will be covered or not.

Despite the fact that health insurance policies vary in terms of what’s considered covered, there are guidelines that most insurance firms follow with regards to the definition of what’s considered necessary or reconstructive and what’s deemed cosmetic.

How Cosmetic Surgery is Defined?

Majority of the carriers follow the provided definitions of AMA or the American Medical Association as well as the ASPS or American Society of Plastic Surgeons.

  1. Reconstructive surgery refers to a form of surgery performed on an abnormal structure brought by developmental abnormalities, congenital defects, infection, trauma, disease or tumors. This includes surgery to further improve function or perhaps, to provide normal appearance.
  2. Cosmetic surgery reshapes a normal structure on the body with a goal to improve the patient’s appearance or self-confidence.

When it is Considered Medically Necessary?

Simply speaking, insurance companies interpret the definitions above. It’s entirely up to them to make the decision and might change in the long run based on:

  • The type of health insurance a person have
  • Research and how they are relating the needs of patients
  • The evolution of medical treatments and new procedures

Until these criteria are met, that is the time when the health insurance company will be covering for the procedure.