Cosmetic procedures

Cosmetic procedures are elective medical treatments that aim to enhance appearance rather than treat medical conditions. Health insurers, including UnitedHealthcare and Cigna, generally exclude coverage for cosmetic procedures like rhinoplasty or breast augmentation unless medically necessary.

The IRS does not permit taxpayers to deduct expenses for cosmetic surgery not required to improve function, based on IRC Section 213(d). Most employer-sponsored health plans define cosmetic procedures as non-covered except after trauma or congenital defect repair, per Kaiser Family Foundation analysis.

Blue Cross Blue Shield requires documentation of functional impairment before approving reconstructive but not cosmetic surgeries. Insurers typically consider Botox injections for wrinkle reduction and chemical peels as uncovered cosmetic services, as reported by https://yourinsurance.info.

Cosmetic dental procedures, such as teeth whitening and veneers, do not qualify for coverage under major dental insurance plans like Delta Dental. State Medicaid programs exclude most cosmetic procedures unless necessary due to accident or disease; Texas Medicaid cites this restriction explicitly.

Medically necessary exceptions include breast reconstruction post-mastectomy under the Women’s Health and Cancer Rights Act of 1998. Medicare covers limited cases of reconstructive surgery but denies payment for purely aesthetic changes according to CMS guidelines.

Appeals processes for denied claims on cosmetic grounds require submission of medical necessity evidence by providers, as stated by Aetna’s clinical policy bulletin.