Health Plan Covers or Not Plastic Surgery?

Can the health plan cover the cosmetic surgery you're eager to do?

Brazil is that the second country within the world in terms of cosmetic surgery , with quite 1.46 million cosmetic procedures performed, second only to the us, which totals quite 1.56 million.

The dream of the many women and therefore the desire, increasingly assumed, of the many men, the foremost common procedures are silicone breast implantation, liposuction, abdominoplasty and eyelid surgery (blepharoplasty).

But do health plans cover cosmetic surgery ? during which cases is it possible to enjoy the benefits? is that this subject of interest to you? So, pay close attention to ascertain if you fit into any of the situations that we'll present below!

When does the health plan cover plastic surgery?

A priori, the health plan covers cosmetic surgery . In fact, the National Supplementary Health Agency (ANS) lists which procedures the agreement must cover. These are called reparative interventions, like breast reconstruction and therefore the elimination of excess skin.

For this, however, it's essential to rent an outpatient hospital plan. However, there are surgical techniques that aren't listed within the organ list. during this case, it's necessary to see if the choice is mentioned within the contract.

Therefore, you'll only perform plastic surgeries under the plan if they're a part of the ANS list or are provided for within the contractual relationship. Otherwise, coverage covers consultation and preoperative exams. The expenses associated with the procedure, on the opposite hand, must be fully purchased on their own account.

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What is Plastic Surgery?

Plastic surgery may be a procedure that aims to reconstruct a neighborhood of the physical body for medical ( restorative cosmetic surgery ) or aesthetic ( aesthetic cosmetic surgery ) reasons .

What plastic surgeries does the plan cover?

See below what plastic surgeries the health plan is required to hide, consistent with the ANS.

Excess skin removal

The surplus skin removal surgery is aimed toward patients who have undergone a stomach reduction procedure (bariatric or gastroplasty), which is performed to treat morbid obesity, considered a disease.

As the surplus compromises the beneficiary's health and lifestyle - it can cause infections and affect the spirit - he's entitled to cosmetic surgery with none burden.

Breast reconstruction

Another cosmetic surgery  included within the mandatory coverage is breast reconstruction for ladies who have had a masectomy. The law provides coverage for beneficiaries diagnosed with carcinoma, traumatic injuries and tumors generally.

This also applies to the mastoplasty on the other breast after reconstruction of the contralateral, in cases of traumatic injuries and tumors. It are often done only on one breast, if the opposite is healthy.

In this situation, the procedure is additionally associated with a problem of physical and emotional health (breast cancer, depression, inclusion in society, etc.).

Breast reduction

If the dimensions of the breasts affects the patient's health, he's entitled to reduction cosmetic surgery , called by doctors as breast hypertrophy. it's worth remembering that the surplus breast weight can cause spine and posture problems in certain situations.

Keloids, hypertrophic scars and burns

Although, in these cases, cosmetic surgery features a more aesthetic sense, the intervention aims to repair the results of a ill health that, in fact, can affect the patient's emotional well-being. Therefore, the plan is obliged to supply the corrective procedure.

Blepharoplasty

Blepharoplasty itself, the third most wanted cosmetic surgery within the country , can also have a clinical indication. this happens when the eyelid is so drooped that it seriously interferes with vision, causing risks to the beneficiary.

However, it's necessary to possess a medical indication, also as entering a file with the operator posing for the procedure to be performed, which must be analyzed by the health plan.

If the operator disagrees with the doctor's indication, a 3rd doctor chosen, in agreement with two other professionals, should be consulted for the ultimate decision.

The remuneration is borne by the insurer, in accordance with the provisions of ANS RN 319/2013 . The beneficiary can attend court to request the surgery, if there's still a negative.

Orthoses and prostheses

The coverage of cosmetic surgery is mandatory also within the case of orthoses, prostheses and their appendages related to surgical practice. it's worth remembering that the determination is valid in plans with coverage for hospitalization, as long as the aim isn't only aesthetic.

What is the difference between restorative cosmetic surgery and aesthetic plastic surgery?

The cosmetic surgery reconstructive is formed to correct disfiguring injuries, congenital or acquired defects. Being considered as important as the other surgical intervention.

Already cosmetic surgery aesthetics is formed by the patient so as to enhance something in their appearance.

Thus, this sort of surgical intervention isn't through with the aim of achieving some improvement in health, but rather to vary some physical aspect that doesn't please the patient. Like, for instance, a prominent ear, which is popularly called a protruding ear, or within the case of flabby breasts. In other words, these situations don't cause physical damage to the patient, but psychological.

Thus, in any plastic intervention, it's intended that the affected site, additionally to maintaining its natural appearance, has its normal functioning.

What to try to to when the surgery is for aesthetic purposes?

Health plans aren't required to hide cosmetic surgery aesthetics . this is often because they're classified as elective by ANS. However, if you concentrate, there's a “catch” therein sentence. In fact, quite one. the primary is that they're not required, but they're also not prohibited.

As not all health plans are an equivalent, if the operator wants to hide the procedure, it's enough to incorporate the coverage for cosmetic surgery , serving as a differential in reference to the competition.

After all, although there are some rules in common between all the agreements, it's possible that every one has extra benefits, which can change over time.

In this case, the tip is to understand the health plan well before hiring. ask the specialist salesman, explain your wishes and wishes to him and, especially, read all the clauses of the contract so you do not have any unpleasant surprises later.

When the agreement promises to hide cosmetic surgery, make certain that this obligation are going to be clear within the contract. Likewise, the document will specify whether the procedure is said (or not) for health purposes only.

Health at stake

The second “catch” is that the following: we all know that ANS doesn't really recognize the requirement to perform aesthetic procedures. However, when this sort of surgery is additionally associated with some health issue, Law 9,656 / 98 lists some very specific cases (removal of excess skin, for example).

It is different, however, from cosmetic surgery for aesthetic purposes only, like liposuction. during this case, the beneficiary will only obtain coverage for preoperative exams and consultation. The rest, like hospital expenses and medical staff, aren't covered by the agreements.

Therefore, the advice is usually to speak tons and during a sincere way with the health plan seller and punctiliously read all the clauses of the contract before signing it.

How to request a plastic surgery?

As we've seen, the health plan covers cosmetic surgery for health and, in certain cases, aesthetic purposes. But the way to request it? First, it's necessary to follow the bê-a-bá already known by all who use a medical insurance. That is,

consultation should be scheduled;

express interest in doing the procedure;

go through evaluations and take the exams.

It is worth remembering, however, that such procedures usually require a grace period. Therefore, it's essential to see, beforehand, if cosmetic surgery is feasible or if the contract stipulates a period of validity before it are often performed.

In case of emergency surgery , you'll request partial or full reimbursement later, counting on the contractual conditions.

It is also noteworthy that the reparative surgeries require medical communication, through a report, attesting to the necessity for the procedure to market the patient's health.

However, we remind you that the operator may request the evaluation of another professional before authorizing the surgery. during this situation, it's the corporate itself that has got to cover the expenses for the services provided by the doctor.

The guideline is to consult the operators that operate in your region and punctiliously analyze what each of them has got to offer. Also, do a web simulation to seek out out which of the choices most closely fits your budget.

Last, but not least, make certain to try to to it in time of need, as we never know when it'll arise.

Understanding during which cases the health plan covers cosmetic surgery and knowing that the repair procedures are mandatory consistent with ANS, it's important to watch if the contracted agreement offers options for strictly aesthetic purposes, if you're curious about using these services.

Now that you've got acknowledged once you can use the decide to request cosmetic surgery , how about clearing up other people's doubts about the subject? Share this post on your social networks!

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