Elective Surgery & Insurance

Despite increasing healthcare costs across the country, there are many people who are still willing to have elective surgeries, meaning they have surgery by choice, not out of necessity.  And, while some go under the knife to remedy a medical or physical abnormality, there are those who succumb for reasons of vanity, wherein they simply want to conform their bodies to an ideal physical image that they have in their minds. Conversely, elective surgeries are not always about aspiring to be better looking, or leaner in frame. Couples who are trying to conceive a baby via In Vitro Fertilization (IVF) for example, are also considered to be seeking an elective surgery option.

I’m Obese and I Want to get Gastric Bypass Surgery. Will I be Covered?

At iCan, it’s not uncommon for a client to call in with an inquiry relating to elective surgery and whether or not their procedure costs will “go towards” their deductible and/or be covered. Questions like the one above and those below are viable queries we’ve been asked:

I’ve had 3 children and I’m going to get a tummy tuck. Will the cost of my surgery go towards my deductible?

I’m getting a nose job for my Sweet 16, will it be covered if I have a deviated septum?

I’ve been made fun of long enough for having male breasts. I want to have them reduced. Since I’m a guy and they shouldn’t be this big, will my insurance cover this?

Separation of Insurance and State

Although the Healthcare Reform Act will lead you to believe that all pre-existing conditions will now be covered by your insurance policy, it’s just simply not the case. There are caveats that inhibit that from being a reality. The same is true for elective surgery. However, when it comes to having an optional procedure performed, the answer lies in where you live and what you’re having done. In the state of FL for example, gastric bypass procedures are typically covered in some capacity (depending on your policy), but they are not covered in the state of California.

Geography rules grants and engagement. Therefore, the only action that any credible, licensed agent will tell you to take is this: CALL YOUR HEALTH CARE CARRIER BEFORE PROCEEDING WITH ANY AND ALL ELECTIVE SURGERIES! Again, coverage and/or deductible allowances will depend on what state you live in as dictated by state documents, state laws and state forms, so be sure to check your SPD (Specific Plan Decisions) with your healthcare provider today.