Whether insurance will cover your plastic surgery in Jacksonville depends chiefly on the type of plastic surgery you choose. The primary consideration is whether your will undergo a cosmetic plastic surgery or a reconstructive plastic surgery. Jacksonville’s Garcia Institute defines the two using the same definitions adopted by the American Medical Association and the American Society of Plastic Surgeons. We define cosmetic plastic surgery as a surgery “performed to reshape normal structures of the body in order to improve the patient’s appearance and self-esteem;” and reconstructive plastic surgery as one “performed on abnormal structures of the body, caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease.” Reconstructive plastic surgery primarily is performed to restore or improve facial functions such as the ability to smile, open and close your eyes or speak clearly, but may also be done to restore or approximate a patient’s normal appearance.

Insurance companies typically cover reconstructive plastic surgeries that restore functionality and aesthetics lost to injury or disease. In some cases, insurance companies are required by state or federal law to cover specified procedures. For instance, Florida law requires insurance companies to cover cleft lip and cleft palate reconstructive plastic surgery for Jacksonville patients age 18 and younger. And a Congressional committee is deliberating the proposed Children’s Access to Reconstructive Evaluation and Surgery Act (CARES Act), which would require group an individual health insurance plans cover treatment of congenital or developmental deformity or disorder caused by trauma, infection, tumor or disease in minor children nationwide.

However, most laws mandating coverage of reconstructive plastic surgery in Jacksonville and elsewhere affect only minors. So, coverage of adult reconstructive procedures depends entirely on the individual’s insurance plan and unique circumstances.

No insurance company will cover what is often called “vanity-driven” cosmetic plastic surgery. Jacksonville patients and others nationwide are responsible for paying for surgical procedures performed simply to improve the aesthetics of the face. Cosmetic surgery is proven to help boost a patient’s self-esteem and almost invariably encourages patients to take better care of their health. Patients often report that their newfound confidence and a determination to prolong the positive results of their procedures encourages them to exercise more, eat and drink healthier and relax, all leading to improved emotional, mental and physical health. However, such procedures certainly are not “medically necessary,” so insurance companies will not cover them.

There do exist some “gray areas” when it comes to insurance coverage of plastic surgery. Jacksonville patients undergoing procedures that can be considered both reconstructive and cosmetic sometimes get a break on payment. For instance, a blepharoplasty procedure (eyelid surgery) that addresses a severely hooded eyelid that partially obscures a patient’s vision certainly will improve the aesthetics of a patient’s face, but can also improve his or her vision. So, an insurance company may cover a portion of the cost. A rhinoplasty (nose job) procedure that repairs a deviated septum also can address both functional and aesthetic issues. So, the portion of the surgery that improves a patient’s breathing may covered, whereas the portion that corrects cosmetic issues will not be covered.

No reputable surgeon or firm will attempt to help you get coverage for a strictly cosmetic plastic surgery – Jacksonville’s Garcia Institute included. However, we will work diligently with you and your insurance company to get coverage of reconstructive procedures that may qualify. We also accept major credit cards and work with financing companies including CareCredit and CapitalOne Healthcare Finance.