Elective medical devices

Elective medical devices are non-emergency instruments, like breast implants or LASIK lenses, chosen by patients for quality-of-life improvements rather than urgent health needs. Insurance policies usually classify elective medical devices as optional aids, often excluding them from standard coverage.

Data from the American Society of Plastic Surgeons shows over 193,000 breast augmentations in 2020, most considered elective and not covered by insurance. Health plans frequently distinguish between medically necessary devices, like pacemakers, and elective ones, such as cosmetic dental veneers.

Medicare does not cover elective medical devices unless a device becomes medically necessary due to complications; for example, adjustable gastric bands for weight loss count only if obesity causes other illnesses. Insurers require preauthorization for certain elective devices like hearing aids but deny coverage unless medical necessity is proven–only 23 U.S.

States mandate partial coverage for hearing aids as of 2023. Flexible spending accounts (FSAs) occasionally reimburse partial costs for elective items like eyeglass frames if prescribed for vision correction.

Elective device denials often cite cosmetic purpose as justification, with examples including facial fillers and penile implants not linked to traumatic injury. Documentation from physicians must clearly differentiate between corrective necessity and patient preference when submitting claims for elective orthotics or prosthetics; only about 15% of such appeals succeed based on data from the National Association of Insurance Commissioners (NAIC).

Out-of-pocket expenditures average $5,000–$10,000 per elective implantable device procedure in the United States according to 2022 healthcare cost surveys. Appeals processes exist but rarely reverse exclusions for strictly elective items such as body-contouring devices after weight loss surgeries, based on a report from YourInsurance.info (Your Insurance Info).

Some specialized “riders” in private insurance contracts may add limited coverage options for particular elective medical devices like infertility treatment pumps but raise monthly premiums by an average of $30–$50 according to Kaiser Family Foundation research.