Cosmetic procedures like implants and facelifts generally aren’t covered by insurance and must be paid out of pocket. Dr. Byrne says this “can influence patient decisions and may limit access to elective treatments for those who desire aesthetic improvements but are constrained by cost,” and that the onus is on surgeons to “provide thorough counseling” to make sure their patients “fully understand financial commitments involved.”
Dr. Byrne explains that “while insurance helps facilitate access to necessary reconstructive surgeries, it also introduces challenges related to administrative complexity and treatment delays. For cosmetic surgery, the lack of coverage means that both patient choice and financial considerations play a larger role in the decision-making process.”
Theda Kontis, MD, a double board-certified facial plastic surgeon in Baltimore and past president of the AAFPRS, says that her staff is currently “overwhelmed” with insurance requirements and she is considering outsourcing some of the work.
Adds Dr. Hollenbeck, “There’s often some sort of extra effort that you have to make as a surgeon to get the pre-approval done, and that’s very time consuming and frustrating.” There are “denials, appeals… So nothing is ever really that easy.” It can mean that “the patient is upset with the insurance company but also the doctor, and you’re just trying to help them.” He continues, “The thing that’s really frustrating is [when] you don’t really understand what it is that [the insurance company is] looking for, what it is that’s driving the denial, or what it is you’re supposed to say or to tell them. It is a little bit opaque.”
Says Dr. Kontis, “People will say to me, ‘Well, don’t you just give the insurance company all the information ahead of time? And then they decide if they’re going to cover it or not?’” She explains, “a 100% of what I did years ago, that’s how it would be done. But now, a lot of times they won’t even tell you if they’re going to cover it until you’ve done the surgery, submitted everything, and then they say, ‘No, we’re not covering it.’”
Dr. Kontis also notes, however, that “most of what I do reconstructive-wise is just skin cancer stuff, and generally they don’t disapprove of that. If you cut a cancer out, you’ve got to close it [up].”
What’s “really problematic,” says Dr. Hollenbeck, is when a procedure is denied after the surgery. “You have no way of really recouping that at that point,” he points out, adding that in those instances, the cost is often absorbed by the doctor or hospital. “It’s pretty rare that people go after the patient in those situations.”
