When Is Elective Surgery Covered by Insurance in SC - Cosmetic Surgery

Most everyone knows that elective surgery is generally not covered by health insurance plans in South Carolina. Insurance is designed to provide benefits for the unforeseen – the medically necessary. Most elective surgery is not medically necessary but of a cosmetic nature, designed to improve one’s appearance.

However, some types of cosmetic surgery will be covered in certain circumstances. It will all depend on the type of surgery and the benefits provided under your health insurance policy.

For instance, two of my friends recently had “tummy tuck” surgery, to help rid them of the bellies they had acquired after having two children. The surgery of one of my friends was covered by insurance while the other’s was not, even though they were covered by the same employer group health plan. The reason why the surgery was covered for the one friend is because her doctor certified to the insurance carrier that the procedure was necessary to rid her of excessive hidden scar tissue from two C-section deliveries, which was interfering with her menstrual cycles. Also, the excessive weight was putting additional strain on her back, which had recently been operated on for a bulging disk. So, while one friend paid less than $200 for the surgery, the other ended up paying almost $5,000. It all depends on the case.

Also, most companies will pay for a cosmetic procedure when it is of a “reconstructive” nature, such as following an accident or major surgery. For example, if a child has a large tumor removed, resulting in reduction of jaw or cheek bone, causing a facial deformity, the insurance carrier will pay for the services, in most cases.

Another alternative would be to look into purchasing a discount medical plan. They often provide discounts off the price of various types of insurance, but be aware that you will still have to pay the majority of the cost of the procedure and that a discount plan is not major medical insurance! Sometimes these discount plans will work together with your insurance carrier, if the insurance carrier is willing, to provide even greater benefit to you.

If you decide to go ahead and have elective surgery, such as a face lift, an eyelid lift, or a tummy tuck, be sure to read your policy first and even check with your insurance company before you go under the knife so you don’t wake up to nasty billing surprises in the mail.

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