Are there any practitioners who will provide Sculptra or other treatment under medical coverage? FEP Blue Cross (Photo)

Question

I am a male 48 in Santa Clara, CA and from 2002 to 2015 I lost Fat/Tissue only on the left cheek to the temple area and the reason is not known. Anyone accepts Blue Cross Blue Shield?

Kimberly Butterwick, MD · Answer

It’s unlikely that your insurance would cover Sculptra injections to replace lost tissue, because it seems to be primarily a cosmetic concern. Insurance sometimes does reimburse procedures that could be considered cosmetic — but only if they also present a functional challenge. For instance, upper eyelid surgery is sometimes covered because hooded eyes interfere with your ability to see well. But you must meet medical criteria, as determined by an ophthalmologist. However, if the concavity of your face troubles you, then I’d suggest finding a board-certified dermatologist to take a look, give you an estimate, and then work out a payment plan. Many practices work closely with finance companies to make treatment more affordable with readily available financing plans. The investment is probably worth the boost in confidence you’ll get once you feel happy with the reflection you see in the mirror.

Michael I. Echavez, MD · Answer

Your insurance would need to be contacted first to determine if they would cover Scuptra treatments for one side of your face.  I am not a Blue Cross/Blue Shield provider but if your insurance covers treatment from out of network physicians, we may be able to treat you.  You can contact my office if you would like us to check with your insurance to see if the procedure would be covered.

Jason Emer, MD · Answer

Sculptra is unlikely to be covered under your insurance. Sculptra is a great product for improving facial volume and collagen building, but for best results, I recommend using it in a combination depending on desired results. I combine Sculptra with other fillers, lasers, toxins and skin care to give immediate results. See an expert. Best, Dr. Emer

Quenby Erickson, DO, FAAD, FACMS · Answer

Thank you for posting this photo with you question. Your presentation is not as straight forward as it might seem. You should have a complete work up with a Dermatologist to assess why you have developed the hemi-facial atrophy. There may be a diagnosis that could allow your insurance company to consider this more than cosmetic and in that case, they may cover your treatments.I hope this helps and I wish you very well.Quenby Erickson, DO, FAAD

Mary Beth Mudd, MD · Answer

Medical insurance generally does not cover for Sculptra and other fillers since these are cosmetic treatments not considered to be medically necessary. I would suggest contacting your insurance company to see if these are covered benefits under your plan.  Best wishes, Mary Beth Mudd

Sagar Patel, MD · Answer

sculptra does have medical uses but that would only be covered for HIV lipodystrophy which is the loss of fat that occurs in patients who take medications for HIV called anti retrovirals. This fat loss occurs in the temples and Sculptra is FDA approved for this use so Insurance’s cover it. You’re always welcome to see a surgeon and have it done then submit it to your insurance but it’s unlikely to get covered . Sorry to be the bearer of bad news!

Kristine Brecht, MD (license suspended) · Answer

Aesthetic Rejuvenation with Sculptra, fat Transfer and other fillers are not covered by insurance.Choose an expert.Best. Dr Brecht Seattle, Wa

Are there any practitioners who will provide Sculptra or other treatment under medical coverage? FEP Blue Cross (Photo)

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