Would Insurance Cover my Mole Removal by a Plastic Surgeon?

Question

I have 5 moles on my face and 1 on my neck that get in the way when I'm shaving (they are flat, but my razor catches them sometimes). I was wondering if insurance would typically cover a removal of these moles, and could it be covered if a plastic surgeon did it (to minimize scarring risk)?

Lewis Albert Andres, MD · Answer

Hello! Thank you for your question! Surgical procedures for aesthetic 
purposes, to improve appearance, are not covered by insurance. 
Typically, these as well as complications resulting from such procedures
 are the responsibility of the patient. Procedures that are meant to 
correct functional issues and those which cause health-related issues 
should be covered by your insurance as a medical necessity, with proper 
examination and documentation.  Some insurance plans have exclusion 
criteria for certain procedures.  Also, it is an obligation of the 
surgeon not to attempt to authorize purely cosmetic procedures through 
insurance.   Excision of suspicious lesions are often covered benefits.Discuss your issues and 
complaints with a board-certified plastic surgeon to discuss these as 
well as to examine and assist you in deciding which procedure(s) will be
 the best for you. A discussion of the advantages and disadvantages will
 take place along with the risks and benefits. Insurance companies will 
vary on coverage and is always reasonable to discuss your issues with 
your surgeon and primary care. It would behoove you to get as much 
information as possible and even call your insurance yourself. 
Certainly, pay in advance prior to your surgical procedure and options 
such as financing are available if you qualify. Hope that this helps! 
 Best wishes!

Sam Naficy, MD, FACS · Answer

Depending on the insurance carrier, it is possible to have the cost of mole removal covered by insurance.  Each insurance carrier has specific coverage.  I would encourage you to either contact your insurance company directly or have your physician's office look in to this for you.

Michael I. Echavez, MD · Answer

It is possible that medical insurance can cover the cost of removing moles, even if done by a plastic surgeon.  The decision would be up to your particular insurer.  Either you, or your physician, would need to contact your insurance carrier before your procedure to see if it would be deemed a covered expense.

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