Who Pays for the Cost of Emergency Room After Surgery if It Becomes Necessary?

If something goes wrong and I end up in an ER as a result of a breast augmentation surgery, who will pay for the ER's cost? I asked my insurance company, and they said because it's cosmetic surgery based reason, they don't cover the cost. I called my surgeon's office and the receptionist said if insurance doesn't cover, it would be on me. Really? Then how much I need to be prepare myself for this worst scenario?

Doctor Answers 18

Who pays for the cost of emergency room after surgery if it becomes necessary?

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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.  This is often true, depending on the reason for the visit or surgery.  You should discuss this with your insurance prior and clarify. 

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!

Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Health insurance and cosmetic surgery

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Everyone's health insurance policy is different, however, in general, most health insurance plans do not cover any complications resulting from a cosmetic procedure. You have to read the fine print of your individual plan. It doesn't hurt to try and bill health insurance since they do cover these issues sometimes. However, there are very reasonable priced cosmetic insurance plans that can be purchased prior to your cosmetic procedure that cover complications resulting from the cosmetic procedure. Your plastic surgeon can give you information on these plans that are sold by a separate company. You can also ask your plastic surgeon if you are at increased risk of having a complication and thus worth the extra expense of obtaining the policy.
Best wishes,
Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
4.9 out of 5 stars 42 reviews

Emergency room after breast augmentation

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Going to an emergency post breast augmentation is rarely needed.  In 30 years of practice, we have had one patient go and that was from anxiety.  Each office would handle this situation differently. In our case, we worked with the hospital to waive the fees.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 56 reviews

ER costs and insurance.

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The likelihood of a visit to an ER is very low following a breast augmentation. However, should this occur, the costs can be significant. You have done the appropriate first steps by contacting your insurance provider to see if they cover the costs. There are separate insurance companies which will provide term limited coverage for cosmetic procedures. CosmetAssure is one company that provides this service. Ask your plastic surgeon about this prior to having your procedure done.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

Hospital treatment after elective breast surgery

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Fortunately, hospital treatment after elective breast surgery is rare, especially if you go to qualified plastic surgeon who has been diligent in screening you from a health standpoint for your upcoming surgery. However, emergencies can happen and it will be difficult to predict whether or not a post operative ER visit or hospitalization would be covered by your insurance company. There is a company that provides insurance for complications after cosmetic surgery if the complication occurs within 30 days of the procedure. This company is called CosmetAssure and would be a company that your surgeon contracts with. You may want to consider choosing a plastic surgeon who offers CosmetAssure on the rare chance that you would need ER treatment after surgery.

Antonio Gayoso, MD
Saint Petersburg Plastic Surgeon
4.9 out of 5 stars 33 reviews

Cosmetic Surgery and Emergency Room Visit

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Complications following cosmetic plastic surgery is extremely rare when performed by a Board certified Plastic Surgeon. Most health insurance companies will not cover the cost of ER visits from cosmetic surgery. We offer all our patients CosmetAssure to give everyone the peace of mind about their cosmetic surgery. However, if you are considering cosmetic surgery, make sure that your Plastic Surgeon is a “real Plastic surgeon”. There is a huge difference between Plastic Surgeons and Cosmetic Surgeons. Do your homework you sign the contract. 

Stanley Okoro, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 168 reviews

Who pays for post operative complications?

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Great question.  A trip to the ER is very, very rare after cosmetic surgery but complications can happen and sometimes they need attention after hours.  And sometimes they need hospitalization.  And, oh yeah, it's expensive. 

I cover all of my cosmetic patients with Cosmetassure which covers postoperative complications that occur within 30 days of surgery.  I sleep better at night.  Check out my blog on this topic.

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 77 reviews

Going to the ER after breast augmentation

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Although this is very unlikely, I've heard of it happening and yes, you would likely be responsible for your bills.

Be informed that there are companies, CosmetAssure is one example we carry, that provide insurance specifically for the procedure you are having.  It's a one-time fee paid at the time you sign up for surgery and covers you in case there are problems.

It's like purchasing travel insurance, you don't think you are going to get sick or injured in a foreign land; but if you do, aren't you really glad you bought it instead of being stranded in Timbuktu.  (No offense intended to the kind residents of Timbuktu, Mali. Yes, it is a real place).

I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

Emergency Room Costs after Elective Cosmetic Surgery

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It is extremely rare for a patient to end up in the emergency room after breast augmentation surgery.  Some insurance companies will cover any emergency situation and others will not cover emergency visits that are the result of cosmetic surgery.  It is best to check with your insurance carrier to find out their policy. However, I would proceed with your breast augmentation and not expect to visit the emergency room after surgery. If you experience any untoward issues after the procedure contact your surgeon first.

Rondi Kathleen Walker, MD
Washington Facial Plastic Surgeon

Breast augmentation and emergency room

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While it is a rare occurrence, it could possible happen. Many insurance companied will not cover emergency care after cosmetic surgery.  CosmetAssure is a company that can offer insurance for just this problem.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.