Why aren’t cosmetic procedures covered by insurance? Reasons why.

Why aren’t cosmetic procedures covered by insurance? Insurers don’t cover cosmetic procedures and surgeries under a health insurance policy because they aren’t thought to be important enough to keep a person’s quality of life up or make sure that a body part or system works properly.

Within the last few decades, India’s pharmaceutical and medical business has multiplied, making it one of the best in the world. As a result, the discipline of medical tourism has seen substantial advancement. However, many people in India are unwilling to undergo cosmetic operations because of the high cost and exclusion from numerous health insurance coverage.


Because in most cases it is an elective procedure having nothing to do with your health. On the other hand, corrective cosmetic surgery is frequently covered. This is surgery that is done to correct a defect of function or form.

Frequently covered: breast reconstruction post-mastectomy, cleft palate surgery, etc.

Sometimes covered: tummy tuck post radical weight loss, scar reduction, etc.

and In terms of coverage, Mediclaim policies are neither structured nor developed to cover the costs of cosmetic surgery. If, on the other hand, the treatment is regarded as reconstructive, your health insurance policy will pay the medical costs. The primary reason aesthetic procedures and surgeries are not covered by health insurance is that they are not deemed necessary to maintain a person’s quality of life or to ensure the normal function of a body component or system.

If you’re considering cosmetic surgery to improve the appearance of an external body part or organ, there are a few things to consider. In this post, we’ll discuss the relationship between health insurance plans and cosmetic operations, as well as there are key considerations to keep in mind if you decide to have one.

Taking on the Financial Burden of Cosmetic Procedures

When it comes to cosmetic procedures, the cost and safety of the surgery are the first things that spring to mind. The physician and the plan will determine whether or not the cosmetic surgery you want to get is covered by your health insurance policy. However, whether the procedure was reconstructive or cosmetic surgery is the most important factor that health insurance providers assess when processing a claim.

Both of these medical procedures are comparable to one another while still being fairly different. Let’s take a look at both of these processes to see what’s going on.

Reconstructive surgery is a term used to describe surgical procedures that are used to correct trauma, physical flaws, maladies, or diseases. An accident or a genetic anomaly could have resulted in physical trauma. Typically, these procedures are aimed at improving the overall aesthetics of the damaged organ/body part, as well as its appearance and functionality.

Cosmetic Surgery: Cosmetic treatments, unlike reconstructive surgeries, are performed with the goal of improving the appearance of a specific body area. These operations boost the patient’s self-confidence and self-esteem.

The majority of medical insurance policies cover reconstructive surgery, but not aesthetic surgery. also, Both processes are carried out by the same type of medical practitioners, which is an intriguing aspect to contemplate.

When is Plastic Surgery Covered by Mediclaim?

Plastic surgery coverage under your health insurance policy is determined by your provider’s criteria and the medical procedure’s definition. It’s critical to know whether the procedure is covered by your Mediclaim coverage in order to understand and determine whether it’s covered:

The procedure is purely aesthetic.

The procedure is rehabilitative.

It’s a life-saving procedure.

In most circumstances, the medical expenses incurred will be reimbursed by the health insurance policy if the procedure is reconstructive or life-saving. The easiest method to find out is to call your insurance provider directly with all of the details of the procedure so that you can fully comprehend the coverage’s complexities.

Some of the most popular operations covered by a mediclaim policy that covers reconstructive and plastic surgery are as follows:

Surgical procedures to correct congenital defects such as cleft palates, cleft lips, and nasal deformities that cause breathing difficulties.

Reconstruction, grafting, and skin tightening are some of the procedures performed after a burn injury.

Reconstructive procedures are performed to help patients recover from catastrophic injuries.

Scar removal


Surgeries followed by cancer or tumour treatment

Is it possible to upgrade the plan I have to include plastic and cosmetic surgery?

Yes, you can add cosmetic and plastic surgery coverage to your current health insurance plan as long as the provider covers the treatments in question. A key item to remember is that maternity services and pre-existing medical illnesses or disorders are subject to a 12-month waiting period. It may, however, differ from one insurer to the next.

It’s all in a nutshell!

The number of providers who provide coverage has increased as the popularity of cosmetic and plastic operations has grown. To acquire the best plan at the greatest price, you can research, compare, and shortlist different providers and plan online based on your needs.

Many people in the United States don’t know that their insurance company will pay for a wide range of cosmetic and surgical procedures if they improve a person’s health or are part of a reconstruction process. When someone has breast cancer, for example, they must have breast surgery to rebuild the breast tissue after having a mastectomy. This is required by law.

Many times, cosmetic surgery can help people who have been hurt or have a physical problem that makes their lives more difficult. Insurance may pay for surgeries for people who have chronic pain, like breast reductions for people who have a lot of pain because of their breast development. Birth defects like cleft palates, warts that make it hard to see, and other problems may also be covered. Another example of a cosmetic procedure that can hurt someone’s health is when a person has a very hooded eyelid. Even though blepharoplasty isn’t fully covered by insurance, at least part of the procedure can be paid for.

People who have lost weight and had gastric bypass may also be able to get surgery for sagging skin, such as a panniculectomy, Brachioplasty, and in some cases, a butt lift. People who have a lot of loose skin can have bacteria build-up, yeast infections, ulcers, and back pain, which makes this procedure more medically important than a cosmetic one.

One of the procedures that may be covered by insurance but isn’t cosmetic is one that fixes a deviated septum, which can make it hard for people to breathe and increase the risk of getting a bad infection. A deviated septum can be fixed with insurance, but a rhinoplasty to change its shape would not be paid for by insurance.

Most of the time, if the surgery is only meant to improve a person’s looks or boost their confidence or mental health, insurance may not pay for it. Surgeries that only focus on improving a patient’s health and addressing specific medical issues are the ones that are often covered in part or in full by insurance.

Health care providers, how easy they are to get to, and how much they charge vary from person to person. also, talk to both your doctor and your insurance company about how much it’ll cost and how you’ll plan your next surgery. If you have health insurance or see a doctor, they are the only people who can give you information about your plans that is specific to you.

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