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.