Surgeries Your Insurance May Not Cover

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You have health insurance? Great! You want Lasik? Well...

Most health insurance companies won't cover surgeries they consider "elective," or not a medical necessity. Insurance coverage varies greatly from one company to another, however, and the only way to be completely sure what your insurance policy covers is to contact your insurer.

Here are a few common surgeries your insurance company may not pay for:

Lasik Eye Surgery
Many insurance companies will not pay for laser-assisted in situ keratomileusis eye surgery and other forms of corrective eye surgery because, in most cases, it is not medically necessary. Patients may have vision problems, but if they can be corrected by wearing eyeglasses or contact lenses, an insurance company will call it elective. In general, insurance companies don’t want to pay to correct conditions that do not threaten the patient’s health.

If you're interested in getting corrective eye surgery, and your insurance won’t pay for it, there are other alternatives. Many doctors offer payment plan options to spread costs over time. Alternatively, you may be able to get a medical loan to finance the costs. Medical loans tend to have high interest rates, however, so unless you're doing very well you should avoid them. If you have a flexible spending account (FSA) through your employer benefits, you can use this to self-finance. With an FSA you can direct a portion of your salary into your account before taxes. Once you have saved enough, you can pay for your Lasik without having incurred any interest charges. The surgery usually costs between $1,500 and $3,000 per eye.


Gastric Bypass Surgery
Even though obesity is a diagnosable condition that can lead to major diseases such as diabetes, many insurance companies do not cover obesity treatment. That includes weight loss surgeries such as gastric bypass surgery. This is changing, however. More and more insurance companies are recognizing the benefit of weight loss surgery as a treatment of obesity-related conditions. If you have an obesity-related condition, your insurance may cover this surgery. You will need a letter of medical necessity from your surgeon, and additional information may be needed, however. The approval process can be long in some cases, and you may need to appeal the first decision if it’s not in your favor. This surgery typically costs between $20,000 and $25,000, so it's very difficult for the average person to self-finance.

Cosmetic and Reconstructive Surgeries
Although cosmetic and reconstructive surgeries are both performed by plastic surgeons, they aren't the same. Cosmetic surgeries are performed on normal anatomy, and reconstructive surgeries are performed on abnormal anatomy. Abnormal anatomy may be caused by a birth defect, trauma or illness. There is a fine line between cosmetic and reconstructive surgery and that line usually determines insurance coverage. Cosmetic procedures like breast augmentation, facelifts and nose jobs are never covered by insurance, but some reconstructive surgery may be. For example, if a patient has a nasal obstruction, a rhinoplasty (nose job) may be covered because it will improve the patient’s breathing. Like weight loss surgery, reconstructive surgery typically requires pre-authorization and a letter of medical necessity.

 

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