Among the most frequently asked questions we receive regarding liposuction, one of the most common is: “Does insurance cover liposuction?”
Unfortunately, the general answer to this question is no. Most of the time, insurance will not cover liposuction. This is because it is not a medically necessary procedure in most cases.
There are exceptions, however. In the post below, we’ll cover these and explain what you’d likely need to do in order to qualify for full or partial coverage.
Do keep in mind, however, that all insurance providers are different. When in doubt, you should go to your provider directly to see what’s covered and what’s not and how coverage can be obtained.
Does Health Insurance Cover Liposuction?
Before we can explore whether your health insurance company will cover your liposuction, it’s important to go over insurance’s approach to plastic surgery in general.
The overarching purpose of health insurance is to cover patients financially if they are sick or get into an accident. This means that surgeries, procedures, medications, and other medical treatments and therapies that are “medically necessary” for the health of the patient are covered.
The trouble is that “medically necessary” is not an entirely clear term. That is, for some patients, a plastic surgery may feel absolutely medically necessary. But for that patient’s insurance company, it may not be.
Cosmetic Surgery vs Reconstructive Surgery
Plastic surgery itself can be divided into two categories: cosmetic surgery and reconstructive surgery.
Cosmetic surgery includes procedures performed for cosmetic reasons only. People get cosmetic procedures so they look better and feel better about their looks. There’s absolutely nothing wrong with this, but these procedures are almost always not covered by insurance. Examples of typical cosmetic surgeries include breast augmentation, tummy tuck surgery, and Brazilian butt lift surgery.
Reconstructive surgery, on the other hand, includes plastic surgery procedures to restore normal appearance and function to the patient. So, for example, if a patient has breast cancer and gets a double mastectomy, she may have reconstructive breast surgery, and this may be covered by health insurance. Likewise, a nose job may be covered if it’s performed to correct breathing issues.
Reconstructive surgeries are not purely cosmetic and may treat underlying medical conditions, birth defects, injuries from accidents, etc.
Health Insurance and Fat Removal: Is Liposuction Covered?
Liposuction is an elective cosmetic surgery that removes unwanted fat from the body. It is most commonly performed on the midsection but can also be performed on the thighs, buttocks, flanks, back, arms, chin, and other regions of the body as well.
It is very rare for liposuction to be medically necessary. Because of this, it is very rare for liposuction surgery to be covered by insurance.
Situations Where Liposuction Cost May Be Covered by Insurance
Again, it is rare, but to get a plastic surgery covered like liposuction, one of the following scenarios would likely need to occur:
- Removing fat due to lipedema to aid with mobility
- Fat transfer to aid with fat atrophy on certain areas of the body
- Fat transfer after a serious injury (such as a burn) to one or more body parts
- Fat removal related to gynecomastia surgery
- Fat removal that is necessary prior to major surgery on someone who is morbidly obese
- Steps Needed for Liposuction Insurance Coverage
Again, not all of the scenarios listed above would definitely ensure coverage. But potentially, if one of those scenarios was occurring, you could inquire with your insurance provider to see if your liposuction would be covered.
Most plastic surgeons would be willing to help guide you through this process as they would likely need to provide evidence of medical necessity to your insurance company. You may also need to get proof of medical necessity from a different doctor (for example, your primary care physician) or a specialist.
In addition to validation from medical professionals, your insurance company might require you to document a recurring need for care in this area. For example, if you are seeking liposuction to improve gynecomastia, you might need to prove that gynecomastia has been bothering you and causing you pain and difficulties for an extended period of time.
Finally, you would likely need to prove that you have sought help with other solutions for this issue. For instance, if you were hoping to correct lymphedema fat accumulation with liposuction, you might need to show that you tried other methods of lymphedema correction before seeking liposuction.
FAQ: Does Medical Insurance Cover Liposuction?
Does insurance cover liposuction for lipedema?
Liposuction patients who suffer from lipedema may qualify for insurance coverage for liposuction. It all depends upon the particular insurer and the different health insurance plans they offer. Talk to your provider.
Does Blue Cross insurance cover liposuction?
There are many different types of Blue Cross insurance and numerous plan options. Coverage depends on what plan you have and whether your liposuction is medically necessary or an elective procedure.
Will insurance cover plastic surgery for fat removal?
If the fat removal (liposuction) is purely a cosmetic procedure, then no, insurance will not cover these procedures. If you require fat removal for a medically necessary condition or concern, it is possible (though rare) that you may qualify for coverage. Talk to your insurance provider to be sure.
Learn More at Your Consultation Appointment
Health insurance and plastic surgery can be tricky to navigate. If you have questions regarding your coverage options for liposuction, we encourage you to contact your insurance provider directly to learn more.
If you have questions about liposuction, your candidacy for the procedure, or plastic surgery in general, that’s where we can help. Please call today to schedule a one-on-one consultation appointment with experienced and board certified plastic surgeon Dr. Rachel Mason. We look forward to hearing from you!
References
https://www.healthline.com/health/medicare/does-medicare-cover-liposuction