Insurance and Plastic Surgery: Key Factors Considered

insurance plastic surgery factors

There are several important themes you may be wondering about if you’re looking into any kind of plastic surgery procedure, and one of these is whether you will be covered by insurance. Many plastic surgery procedures are indeed covered either fully or partially by most insurance policies, but there are also cases where this will not be an option. 

At the offices of Steven Warnock MD, we’re happy to assist with this and any related needs for all of our plastic surgery procedures for Salt Lake City and other Utah clients, from rhinoplasty services to breast surgery, body sculpting mommy makeovers and more. In this two-part blog series, we’ll discuss the key factors that play a role in whether your insurance company is likely to cover your plastic surgery procedure, plus some general tips on increasing your chances of approval.

Main Factor: Medical Necessity

While this is not the only factor considered, and we’ll discuss others in a moment, by far the most notable element when it comes to whether your plastic surgery procedures are covered by insurance is whether the procedure in question is classified as a “medical necessity” for you. Under most policies, this means that the procedure must be necessary for health reasons – not cosmetic ones – in order to qualify.

For instance, if you were born with a severe facial asymmetry and needed rhinoplasty as part of a reconstructive procedure, it’s much more likely that your insurance company would cover this than if you simply wanted your nose to look different. Other procedures may also fall into the medically necessary category depending on various factors, such as breast reduction or augmentation for chronic back pain caused by overly large breasts.

Additional Factors

There are many cases, however, where procedures considered “cosmetic” may be deemed necessary for health, functionality or even psychological reasons. In these cases, you may still be able to get coverage – it’s just that the process is often more involved, and there are several other factors that your insurance company will consider when determining whether to cover the procedure:

-The physician’s recommendations

-Your medical history

-Any pre-existing conditions you may have

Our next several sections, and on into part two of our series, will discuss some common procedures and when they’re typically covered – or not covered – by insurance.


As we alluded to above, rhinoplasty can be covered by insurance in some cases, particularly if you have a medical condition like a deviated septum or conditions that cause chronic sinus infections. Others may be covered due to breathing problems or sleep issues caused by the shape of your nose, while still others may fall under reconstructive surgery due to other facial deformations.

On the flip side, if you’re looking for a rhinoplasty solely to change the shape of your nose, it’s unlikely that insurance will cover this procedure. In some cases, though, insurance companies may consider procedures like septoplasty (to correct a deviated septum) and otoplasty (for protruding or large ears) as medically necessary, and thus may cover them.

The bottom line: Every case is different, so be sure to speak with your plastic surgeon and insurance provider to get an accurate understanding of what procedures you’ll need approved before they can be scheduled – and whether they will or won’t be covered by your policy.

For more here, or to learn about any of our plastic surgery procedures for Salt Lake City and elsewhere in Utah, speak to the staff at the offices of Steven Warnock MD today.