Cosmetic Surgery

When is Otoplasty considered reconstructive vs. cosmetic?

I have been interested in otoplasty for years now. I understand that cosmetic surgery is barely covered by health insurance since cosmetic surgery is to improve your physical look and boost your self esteem. But I was reading that Otoplasty can sometimes be considered reconstructive, and somewhat covered by health insurance. Those reasons are: deformation at birth, disease, or truama. My ears, since birth, are folded a bit on the top. I do want the surgery to boost my self esteem considering I have been self concious of my ears for years! If I did go for Otoplasty, could it be considered reconstructive surgery? (covered by health insurance) vs. cosmetic (not covered by health insurance) In these hard economic times, Otoplasty for me is pretty much out of the question, but if it’s considered reconstructive vs. cosmetic, it would be covered by health insurance more, and maybe more of a possiblity. Please answer ASAP. Looking for answers now! Thanks. (:

For an insurance company to cover this type of surgery, the diagnoses must not only be congenital, but it must also be an anomaly, meaning that it is a problem. The diagnoses codes on the claim form submitted by your surgeon’s office must be medical codes, not cosmetic codes, and the medical records (which I’m sure your insurance company will request upon receipt of the claim) must back that up. It is important that the medical records also show that the surgery was done for medical and not for cosmetic reasons, because even if the diagnoses code on the claim says that it was done for a medical reason, the insurance company can still deny the claim saying that it is cosmetic if the medical records show that the surgery was not medically necessary.

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