Does Hospital Insurance Cover Plastic Surgery?

When it comes to an intervention or treatment of a purely aesthetic nature, hospitalization insurance does not intervene. On the other hand, if it is a reconstructive surgery following, for example, an accident or breast cancer, most hospitalization insurances provide cover, at least according to the conditions, ceilings and percentages, compensation, etc. determined in the contract.

If you find your nose to be way too big or your breast size too small, you won’t be able to rely on hospital insurance to satisfy your desire to change your appearance through plastic surgery. Inami does not intervene for this type of intervention, either. In such a case, it is the patient’s deliberate choice to undergo such an operation. From a legal point of view, insurance can only intervene if it is an uncertain risk. A deliberately chosen cosmetic / plastic surgery operation, which is not medically necessary, is not uncertain.

When a woman is recovering from breast cancer, for example, and she wants breast reconstruction, the process is not just limited to “wanting to look more beautiful.” The same goes for someone who comes out disfigured from a serious car accident, etc. In such situations, almost all hospital insurance covers reconstructive surgery. Of course, it is as always necessary to take into account the possible deductible, the compensation limit, and other aspects.

You should therefore read the general and specific conditions of your insurance contract in order to see to what extent your hospital insurer will reimburse your intervention.

What Reimbursement For Cosmetic Surgery?

Regarding the reimbursement of cosmetic surgery acts, the purpose of the operation and the origin of the defect to be corrected should be taken into account. Thus, a distinction must be made between cosmetic surgery, called comfort surgery, and reconstructive surgery. The latter aims to repair an injury to appearance or physical integrity. It can be the result of physical trauma, a congenital malformation, or an illness. As for cosmetic surgery, it aims to correct a part of the body considered by the patient as a defect and source of complexes for him.

The reimbursement of cosmetic and plastic surgery usually depends on this distinction. Social security has thus established criteria to distinguish between comfort surgery and repair surgery.

The abdominoplasty is reimbursed by social security on the condition that the excess skin covers all or part of the pubis. A prior agreement is necessary to benefit from this reimbursement. This means that the surgeon must complete an application form, which the patient must send by registered mail to his primary health insurance fund. If there is no response within 15 days, the agreement of social security is presumed. It is, however, preferable to relaunch your primary health insurance fund to obtain a formal agreement.

You should know that the cost of cosmetic surgery by social security does not cover all costs. Fee overruns are frequent. It is, therefore, the complementary health that will take over depending on the level of guarantees subscribed.

Reimbursement of other cosmetic surgery operations

The cosmetic surgery operations covered by social security are:

  • on the face: rhinoplasty if it aims to correct a deviation of the nasal septum or a breathing disorder;
  • otoplasty (re-gluing of the ears) when the protruding ears of the patient are a source of complex or embarrassment in his social life;
  • correcting birth defects such as cleft lip or cleft lip;
  • jaw operations when a chewing disorder is associated with it.
  • at chest level: breast reduction of at least 300 grams;
  • breast augmentation when the asymmetry between the two breasts is greater than one cup or the cup size is less than A;
  • breast reconstruction after breast cancer.

Cosmetic surgery operations carried out following burns, bites, or accidental trauma are also covered, as are certain operations for reshaping the silhouette after obesity surgery.…

Plastic Surgery: What Is Reimbursed And What Is Not

The reconstructive surgery, born of the reconstruction of “broken faces,” following the devastation of World War II, designed to restore integrity to a face or a damaged body. Considered as therapeutic, it is supported, unlike cosmetic surgery, an “accessory surgery” which is not based on medical reasons. But the border is sometimes thin, the two disciplines being moreover united within the same surgical specialty.

Plastic surgery operations on the face

The nose

The intervention is reimbursed if it remodels the nasal septum. A deviated nasal septum is always the consequence of a trauma, a shock, a fight, a road accident, or even a congenital malformation causing respiratory discomfort. On the other hand, a rhinoplasty to correct a nose that is too long, too wide, or too big is not. An operation to correct a bump on the nose, of non-traumatic origin, is not reimbursed, even if it causes a large complex. In the event of breathing problems, however, you can submit a request for prior agreement to Social Security.

Protruding ears

It is a congenital malformation. The operation, which consists of reattaching them (otoplasty), is taken care of in children as well as in adults, from the moment when it causes a significant complex in the young subject or a social discomfort in the adult. These criteria are subject to the appreciation of the plastic surgeon.

The chin in galoche or very elusive: the people concerned can be very complexed, but the operation is supported, with prior agreement, only if the disharmony causes a maxillofacial problem.

Facial rejuvenation

Lifting, eyelid surgery, injections of fat, Botox, or hyaluronic acid are not reimbursed.

Plastic surgery operations on the body

Breasts

  • All breast reconstructions following breast cancer are covered, regardless of the method used.
  • The breast reduction is also provided for prior agreement, provided that the removed weighs at least 300 grams per breast. In most cases, we are sure to remove this weight, but we also sometimes give two quotes to a patient, one with reimbursement, the other without, in the event that the removed part does would not reach 300 g. Surgeons are rarely wrong in their estimates observes a medical insurance consultant. But if finally, about 290 g per breast was removed, the reimbursement is not in question. This flexibility may, however, vary from one fund to another, depending on the medical adviser and his assessment.
  • The breast augmentations are not repaid, after prior agreement, in three situations: the cup size is less than A, the breasts are tuberous (tube-shaped), or asymmetry is very marked, corresponding to at least one cup of ‘difference.
  • The lifting of sagging breasts, even after pregnancy, is not reimbursed.

The belly

The abdominoplasty is an operation that consists of tightening and removing the excess skin on the level of the abdomen. Whatever the origin of severe weight loss, pregnancy, it is reimbursed, after prior agreement, if the skin covers part of the pubis.

Silhouette

Whether it concerns the arms, legs, or buttocks or even liposuction, only operations that follow a significant weight loss after obesity surgery, in particular, can be reimbursed with prior agreement.

The skin

All burns, bites, and scars caused by illness or accident are covered. If it is (pre) cancerous, the removal of a mole may be reimbursed.…