Can an otoplasty be covered under insurance? (photos)

Question

Can an Otoplasty be covered under insurance if it were to be deemed medically necessary because of daily discomfort and pain? I am 22 years old and I suffer from pain and headaches daily because of my ears, not to mention the visual aesthetic... I can't lay my head on a pillow with my ear bent, or wear headbands without pain. Also, any sort of wind causes severe ear aches. I believe this is all due to how prominent my ears are and wanted to know if this could be fixed! Thank you.

Don Fontana, MD · Answer

Otoplasty is sometimes covered when done in children  as it is considered a congenital deformity.  As an adult, it is considered to be cosmetic.

William Portuese, MD · Answer

There is no medical necessity for cosmetic surgery to pin the ears back, so plan on paying for the procedure yourself, since it is cosmetic

Vincent D. Lepore, MD (retired) · Answer

From your photos it appears you have prominent ear with deep concha.  Unfortunately, health insurance companies do not consider this situation a deformity and will not cover the procedure to set the ears back.  Prominent ears are a common problem that  plastic surgeons routinely correct with a surgery which could be performed under local anesthesia.  The procedure takes about 90 minutes to perform.  There are companies which can help provide financing for the procedure in patients who qualify.  Seek out a board certified plastic surgeon who routinely preforms otoplasty procedures.  Best wishes, Dr. Lepore.

Can an otoplasty be covered under insurance? (photos)

Answers (3)

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