Navigating the world of health insurance can be complex, especially when it comes to understanding what types of plastic surgery procedures are covered. Generally, insurance companies cover procedures that are deemed medically necessary. Dr. Robert Kratschmer, a board-certified plastic surgeon in Houston, Texas, frequently helps patients understand which surgeries can be covered by insurance. This post aims to shed light on some of the most common procedures that are often supported due to their medical necessity.

What Does “Medically Necessary” Mean?

In the context of plastic surgery, “medically necessary” refers to procedures that are required to improve or correct a medical condition or to restore normal function and appearance following an injury or illness. These procedures are not merely for cosmetic enhancement but are essential for physical or psychological health.

Common Plastic Surgeries Covered by Insurance

Here are some typical plastic surgeries that might be covered by insurance:

1. Breast Reconstruction Breast reconstruction surgery is commonly covered by insurance, especially after mastectomy due to breast cancer. Dr. Robert Kratschmer emphasizes that this surgery can significantly aid in emotional and physical recovery, helping restore body image and functionality.
2. Breast Reduction This surgery is generally covered by insurance due to its impact on improving pain in the back caused from the weight of breast tissue.
3. Skin Removal After Major Weight Loss Post-bariatric surgery or significant weight loss, excessive skin can be more than just a cosmetic issue; it can cause severe discomfort and skin infections. Removal of this skin, medically known as panniculectomy, is often covered when it poses a health risk.
4. Hand Surgery Reconstructive hand surgery to improve conditions that impair the hand’s function can be covered by insurance. This includes surgeries for carpal tunnel syndrome, rheumatoid arthritis, and other conditions that affect the hand’s ability to function.
5. Eyelid Surgery (Blepharoplasty) When heavy eyelids impair vision, eyelid surgery may be necessary for restoring the field of sight. Dr. Robert Kratschmer often assesses whether eyelid surgery is cosmetic or can be considered medically necessary.
6. Reconstructive Surgery After an Accident or Injury Reconstruction of any part of the body after trauma or injury is generally covered by insurance. These surgeries are crucial for restoring function and preventing further health complications.

How to Determine if Your Surgery is Covered?

Dr. Robert Kratschmer advises patients to consult with their insurance providers to understand the specific criteria for coverage. This typically involves:

• Reviewing your insurance policy in detail.
• Getting a referral from your primary care provider if necessary.
• Submitting required medical documentation that outlines the necessity of the procedure.

Contacting Dr. Robert Kratschmer

For those considering surgery or seeking more information about insurance coverage for specific procedures, contacting a knowledgeable professional like Dr. Kratschmer is crucial. He can provide guidance tailored to your individual needs and help navigate the insurance process.

To discuss your case or for further consultation, reach out to the office of Dr. Robert Kratschmer, board certified plastic surgeon, at 281-317-8179 or via text at 855-922-3330. More information is also available online at SiliconeMD.com.

Disclaimer: This blog is meant for informational purposes only. Individual needs and outcomes can vary. Consultation with a board-certified professional like Dr. Kratschmer is always recommended to address personal concerns and conditions. Individual results may vary. This article should not constitute medical advice. Images shown may be of models and not actual patients.

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