When it comes to finding Dr. Right to perform your nose job, tummy tuck, or eyelid lift, you can’t ask too many questions. Are you board-certified? How many times have you performed this procedure? Where will you perform the procedure?
One question that savvy patients should also ask: If a postoperative complication occurs and medical care is needed, who pays? It’s an important consideration, since complications can be expensive and your regular medical insurance may not cover the cost of a complication if it’s the result of an elective cosmetic procedure—even if it’s medically necessary.
Enter cosmetic surgery insurance, such as CosmetAssure and Aesthetisure, which covers the cost of treating a host of complications within the first six weeks after cosmetic surgery. The exception is capsular contracture, a hardening of breast implants, which has an 18-month or 12-month benefit period after a primary breast augmentation, depending on the company. “The program is designed to make cosmetic surgery safer for patients by providing a financial safety net when complications occur,” says Dr. James Grotting, a board-certified plastic surgeon in Birmingham, Alabama, and the founder of CosmetAssure.
Related: Not Knowing This Before Getting Breast Implants Turned the Procedure Into One of My Biggest Regrets
The cost of complications
Truth be told, most patients don’t ask about a surgeon’s policy on complications, reports Nashville board-certified plastic surgeon Dr. Mindy Haws. “They’re more likely to ask about our policy for revisions,” she says. In one survey, when prospective surgical patients were asked if complications that resulted from the surgery were covered, only one out of 10 were aware that their health insurance plan wouldn’t pay and that they’d be responsible for any out-of-pocket expense related to the hospital or ambulatory costs.
That can be an expensive oversight. Though cosmetic surgery complications are often minor and most can be handled in the office setting at no (or minimal) additional cost, they do happen—one out of 61 surgeries results in a complication, according to CosmetAssure.
For instance, hematomas, collections of blood that often have to be drained, occur in as many as 10% of cases of breast augmentation, the top cosmetic surgery procedure. Major complications, like deep vein thrombosis (DVT), the medical term for a blot clot in the vein, can also occur. “Costs vary widely, based on region of the country and what complication occurs, but on average, the uninsured patient would incur approximately $5,000 to treat a complication,” says Dr. Grotting.
The cost, however, could be far higher, as it almost was for one patient who developed a hematoma following a breast augmentation. It was after hours and her plastic surgeon couldn’t treat her in his office OR, so she wound up getting admitted to a New York City hospital. Her bill for a one-day stay—which included charges for the OR, anesthesia, and recovery room—was $51,000. Luckily, her insurance covered all but $5,000 of the tab, likely because of how the hospital coded the diagnosis, says her board-certified plastic surgeon, who asked to remain anonymous. “If it had put in the coding that the hematoma was a complication of breast augmentation, this would have been a different story.”
That, says Dr. Grotting, is the problem. “If health insurance covers the complication, it’s often because of ‘luck,’ in the sense that the computer filing didn’t clarify that the complication was the result of an elective cosmetic procedure,” he says. “One never can be sure whether health insurance might cover a complication or not.” Insurance provides the peace of mind that the costs will be covered, regardless of whether health insurance pays. Even if it does pay, says Dr. Grotting, insurance would reimburse any out-of-pocket expenses, like copays.
Not all plastic surgeons offer complication insurance, which—depending on the procedure and the insurance coverage—costs from $139 to $289. Those who do say it can be a blessing when a complication occurs. “The majority of patients have never heard of cosmetic surgery insurance, but when you tell them about it, their reaction is, ‘Oh yeah, I want that,’” says Dr. Emily McLaughlin, a board-certified plastic surgeon in Fort Worth, Texas. “It’s money out of pocket up front that the majority of patients aren’t going to need or use, but if you need it, thank God it’s there.”
Cosmetic surgery insurance facts
If you think you’d benefit from the assurance of having cosmetic surgery insurance, here are five key facts you need to know about it.
1. It’s not widely available. The catch with cosmetic surgery insurance is that you have to use a plastic surgeon (only those who are board-certified are eligible) who provides it: surgeons are obligated to enroll every patient undergoing any covered procedure(s) in the program.
Exact numbers aren’t available, but fewer than 1,000 board-certified plastic surgeons—out of more than 6,000 in the U.S.—offer cosmetic surgery insurance. Many who do see it as a sign that they place the best interests of their patients first, and they promote it on their websites as such. They also point it out to prospective patients at the initial consultation. “It’s a selling point for them that offers peace of mind for their patients,” says Paige Hawks, an account executive at Aethetisure.
When he originally conceived of the idea of cosmetic surgery insurance, Dr. Grotting says he thought it would be best to offer it on a case-by-case basis, according to whether the patient or the doctor wanted to buy it. “The actuaries at the insurance companies we were working with at that time convinced me that it was a much better product if the premium could be kept very low and all the patients in a practice could be covered, and they were entirely correct,” he says. “The premium is quite minimal for even larger, more risky cases, but the risk is spread over an entire practice.”
2. Most procedures are covered. Covered procedures include everything from abdominoplasty (aka tummy tuck) to vaginal rejuvenation, though some procedures—including tummy tucks, butt lifts, and body lifts—are charged a higher premium because they carry a higher risk of complications. For instance, a recent review found that minor complications occurred up to 7% of the time in tummy tucks, while major complications occurred in just one out of 13,000 abdominoplasties.
Complication insurance covers procedures performed under local anesthesia, IV sedation (aka twilight), or general anesthesia, and in most cases, it helps pays patients’ medical bills if something goes wrong in the 45 days after their procedure (or up to 18 months, in the case of capsular contracture). In the realm of “something going wrong,” it’s important to note that dissatisfaction with your aesthetic outcome is not considered a covered complication.
3. It will add to the cost of your procedure. Aesthetisure premiums start at $139 ($160 for CosmetAssure) for most procedures and jump to $217 or $289 for higher-risk procedures ($240 for CosmetAssure), depending on the insurance plan. The cost generally appears as part of the cost estimate, says Dr. Grotting. “We show it as an itemized cost but indicate that it’s included and add the fee to the cost of the procedure.” Other surgeons just automatically enroll patients and don’t officially pass on the charge.
Patient pushback is never a problem, which doesn’t surprise Dr. McLaughlin. “Other than the expense, I don’t know of any downside,” she says. “But if a patient is going to routinely invest thousands of dollars for a procedure and this added cost is the deal breaker for proceeding with surgery, then that’s not a patient I want to work with anyway. That’s a very uneducated way to approach elective cosmetic surgery.”
4. The coverage is limited. CosmetAssure and Aesthetisure cover the same 19 complications, including those related to surgery (like hematoma and infection, the two most common complications); the heart and lungs (like arrhythmia, cardiac arrest, and DVT); and anesthesia, including severe hypertension or hypotension. “It’s a very succinct list of what-ifs, and if what’s going on is not on that list, that’s going to be an out-of-pocket expense for the patient,” says Dr. McLaughlin. “It’s not perfect, and patients need to know that up front. It’s not like you’re going to get a $150 insurance policy that covers anything that happens.” That said, “if there’s a complication that results in an admission, an ER visit, or a return to the OR, I think this insurance is invaluable to have for the expenses that patients are going to incur,” says Dr. McLaughlin.
5. The maximum payouts can be modest. One knock on cosmetic surgery insurance is that the payouts are too puny, especially for major metropolitan areas. Depending on the insurance plan a provider opts into, the maximum limit is $5,000 a day for inpatient hospital expense and $3,500 for outpatient emergency expense (for CosmetAssure and Aesthetisure Choice Plan) or $10,000/$5,000 a day (for CosmetAssure Plus and Aesthetisure Premium Plan).
For some surgeons, especially those who have their own ambulatory facility, the cost/benefit ratio can be too high. “You can rationalize it and say that every little bit [of money paid out] helps, but it doesn’t come close to the cost in New York City,” says Dr. John Sherman, a board-certified plastic surgeon in Manhattan. “If you pay tens of thousands of dollars a year to offer the insurance and you get one or two bad complications a year and it only pays a negligible rate for the hospital or ambulatory surgery facility, is it worth it? The answer is no.”
While the maximum limits may not even come close to covering the entire cost in larger cities, the upside of having insurance is that it will give you some negotiating power with the hospital and some of the payment—so that the hospital will often write off the remainder of the bill. “On average, CosmetAssure coverage is able to pay the entire cost of medical treatment through standard limits of coverage and negotiation with medical facilities,” says Dr. Grotting. Hawks says the same is true for Aesthetisure.
Related: 6 Plastic Surgery Procedures Insurance Might Cover
Unprotected: cosmetic surgery without a safety net
Wondering what happens if you have a complication and don’t have insurance? According to Dr. Haws, her practice hasn’t offered cosmetic surgery insurance for 10 years, and in that time, they haven’t had an insurance company deny payment on a complication. “But then again, most of our complications don’t require hospitalization,” she says. If there is a complication, she and her partner waive their surgeons’ fees so that the insurance goes for the hospital or anesthesia—something that’s fairly standard when it comes to cosmetic surgery. Dr. Sherman goes even further: “If I take a patient back into surgery for a complication, I don’t charge them—I pay for everything.”
The upshot, says Dr. Haws: “Insurance is nice to have, but not offering it hasn’t been a problem in our practice.”
Whether your surgeon offers complication insurance or not, it’s important that they clearly illustrate the potential risks of a particular procedure as well as their protocol for avoiding them. Another must, if a surgeon doesn’t offer insurance, is that you check out their policy on complications in advance. Most list it in their pre-op consent form, which usually states that patients may incur an added hospital or anesthesia fee.
