If you examine your NYSHIP Empire Plan plastic surgery coverage, you will come across something that says cosmetic surgery is excluded from coverage. But if you look closely, you’ll notice an asterisk that leads you to the exception — when plastic surgery is considered medically necessary, it may be covered by your NYSHIP Empire Plan in 2024.
When Does Insurance Cover Plastic Surgery?
Your NYSHIP Empire Plan may cover plastic surgery when a doctor determines it’s medically necessary. Medical necessity means it will resolve a condition that hasn’t been resolved with conservative or non-surgical treatments. A classic example is a woman who suffers from chronic neck and back pain due to large breasts. If the woman can show a history of chronic pain or skin conditions from her large breasts that haven’t resolved through alternative means (e.g., exercise or better, more supportive bras), breast reduction surgery would be considered medically necessary and possibly covered by the NYSHIP Empire Plan in 2024.
Plastic surgery may also be covered for other reconstructive purposes. Specifically, women who have had treatment for breast cancer or choose to undergo a prophylactic mastectomy are entitled to breast reconstruction surgery of their choosing (including aesthetic flat closures) and potential revision reconstructions if they experience pain, scarring, or deformity from their first procedure.
The nuances of insurance and the documentation for verifying a medically necessary surgery can be complicated and confusing. That’s why choosing a plastic surgeon with a dedicated insurance liaison who can help you coordinate treatment with your insurance provider is essential.
NYSHIP Empire Plan Plastic Surgery: 2024 Coverage at a Glance
It’s important to remember that no one can guarantee your insurance coverage but your insurance company. However, there are quite a few plastic surgery procedures often determined to be medically necessary.
Here are a few traditionally deemed cosmetic procedures that are often approved as medically necessary and covered by insurance.
The thing to remember when trying to determine your NYSHIP Empire Plan plastic surgery coverage is that it has to be about function. How will this plastic surgery meaningfully improve your quality of life — in a way that can’t be accomplished through alternate methods? The best thing you can do if you’re considering plastic surgery is to work with a provider who understands the ins and outs of medically necessary surgery and has the expertise in the office to help you get the most from your insurance coverage.
Bringing Patient Advocacy to Breast Reduction and Reconstruction
At Harris Plastic Surgery, we are very familiar with the ins and outs of NYSHIP Empire Plan plastic surgery coverage. We can walk you through your options so you can get the right treatment under the coverage you’re entitled to. Contact us to schedule a consult.
Joanne Parrinello, Practice Manager
Joanne Parrinello is an expert patient care coordinator, with two decades of experience navigating the complex financial side of medically necessary breast reduction and reconstruction surgery. She acts as a guide to patients, helping them understand their options and their expected out-of-pocket expense. The insurance industry can be complex and filled with jargon that makes you feel like you need a translator. At Harris Plastic Surgery, Joanne is that translator.