Our plastic surgery patients from Walnut Creek and surrounding areas sometimes choose to correct medical conditions that may be covered by medical insurance. This page aims to help clarify which procedures might be covered by your insurance company and for what reasons. Remember, this is a general reference. You will need to discuss the unique circumstances of your condition with Dr. Mariotti and your insurance company.
Abdominoplasty / Panniculectomy
A panniculectomy – often confused with a tummy tuck – reduces excess skin and fat hanging below the abdomen. While a tummy tuck is performed on people of relatively normal weight, a panniculectomy can be performed on patients whose weight ranges from normal to severely obese and who have lost significant weight. Reduction of the apron of excess fat and skin via panniculectomy can greatly improve a patient’s quality of life, reduce the emotional stress and back pain caused by this disfiguring condition and enhance body hygiene. A cosmetic tummy tuck is never covered by insurance, but removal of only the loose, overhanging skin can sometimes be covered. After an initial exam, we can help you determine whether your condition can be deemed medically necessary.
One of the most popular cosmetic procedures, breast augmentation is usually done for cosmetic purposes. However, this surgery can also correct a congenital difference in the size of the breasts or help adjust the size of a breast which was lost or otherwise affected by disease or injury.
Many women seek breast reduction for aesthetic preference. Often, this procedure is considered cosmetic. However, reducing the breast tissue may be the solution to correcting a difference in size, whether congenital or due to loss by disease or injury. Reduction of very large breasts that are causing back, neck or shoulder pain or causing shortness of breath or difficulty in maintaining proper posture can be sufficient reason for coverage. Enlarged male breasts may also be covered by insurance.
In the case of the congenital absence of a breast or breasts, breast reconstruction is considered necessary. Other justifications for reconstruction include breast cancer, severe fibrocystic disease of the breasts, prophylactic removal of one or both breasts due to strong family history of breast cancer, or loss due to burn or other traumatic injuries.
Explant of Breast Implants
The removal of your breast implants might be covered by your insurance if they are causing you pain. Rarely, if ever, do insurance companies pay for implant replacement or exchange, even if they cover the explantation.
Ear Surgery (Otoplasty)
Otoplasty is performed cosmetically to correct asymmetry, protruding or large ears. In the case of congenital deformity of the ears, absence of one or both ears, deformity or damage by disease or injury, your insurance company may grant coverage.
Eyelid Surgery (Blepharoplasty)
Some people have redundant skin on their eyelids and may seek eyelid surgery to achieve a more vibrant, youthful appearance. In certain cases, the drooping of upper eyelids can interfere with a person’s ability to see well. If the eyelids are turned inwards, causing the lashes to rub against the eye or turned outwards, causing dryness and ulceration of the eyelids, this is a medical problem. Insurance companies may also approve the romoval of certain skin lesions located on the upper or lower eyelids.
Surgery of the Face
There are congenital deformities of the face, head and neck which can be covered by insurance. Moreover, conditions resulting from diseases of the muscles or nerves of the face; asymmetry resulting from paralysis of the facial nerves; and any deformity caused by trauma or injury can be considered.
Liposuction, for any reason, is usually denied by all insurance companies.
We recommend that you discuss the details of your condition and the potential for insurance coverage with your plastic surgeon. Pre-approval by your insurance company will help clarify your share of the payment. You are welcome to call us to inquire which plans Dr. Mariotti participates in. For those plans under which Dr. Mariotti is not a participating provider, we can sometimes work out a case-specific agreement with your insurance company.
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