Should Insurance Cover “Preventive” Cosmetic Surgeries?

What is Preventive Cosmetic Surgery?

Preventive cosmetic surgeries refer to procedures that are mainly performed to address the medical issues that can come up in future. The following are some of the examples of preventive cosmetic surgeries:

1. Mastectomy (removal of the breast) to prevent the risk of breast cancer in future
2. Breast reduction surgery to prevent chronic neck and back pain
3. Rhinoplasty to prevent respiratory problems and breathing-related medical issues caused by the deviated septum in future.
4. Blepharoplasty or eyelid surgery for vision improvement
5. Otoplasty or ear surgery, especially in children, is used to prevent bullying-related trauma
6. If skin rashes and infections occur repeatedly after bariatric surgery for weight loss, abdominoplasty is suggested as a preventive cosmetic surgery.

Cosmetic surgeries are generally done for aesthetic purposes. On the other hand, preventive cosmetic surgery is to prevent the potential health complications in future. There is a grey zone between cosmetic surgery and preventive cosmetic surgery. One is a luxury and the other is a necessity.

Why is There a Rising Demand for Preventive Cosmetic Surgeries?

With the social media influence, increased awareness and healthcare advancements, the demand is rising for preventive cosmetic surgeries. ISAPS Global Aesthetic Statistics indicate a sharp rise in surgical and non-surgical cosmetic procedures. As per the survey, 34.9 million surgical and non-surgical cosmetic procedures were performed worldwide in 2023, with a 3.4% increase globally.

In India, the cosmetic surgery industry is expected to grow at a CAGR of 10% to 12% in the next five years. Alongside cosmetic procedures driven by aesthetic purposes, preventive and reconstructive surgeries are gaining prominence as healthcare awareness and genetic testing expand.

Insurance Industry’s Stance on Health Insurance Coverage for Preventive Cosmetic Surgeries

Standard health insurance plans offered by most health insurance companies in India do not provide coverage for cosmetic surgeries performed to improve appearance or for pure aesthetic purposes. However, reconstructive cosmetic surgeries that are done post-accident or post-cancer recovery are generally covered under most health insurance plans in India. When it comes to preventive cosmetic surgeries, the coverage is offered on a case-by-case basis by the health insurance companies. Here are a few examples of that:

• When rhinoplasty is performed to address functional impairments like a deviated septum or nasal trauma, insurers often cover the cost. This can prevent medical conditions like sleep apnea.
• After a bariatric surgery, patients may have excess skin, causing infections or hernias. Abdominoplasty performed as preventive surgery is often covered by insurance companies.
• Women suffering from macromastia (huge breasts) may endure chronic back and neck pain. Breast reduction in this context is recognised as medically necessary and covered. Conversely, surgeries purely for aesthetic breast augmentation are generally excluded.

Argument on Health Coverage for Preventive Cosmetic Surgeries

Two main factors considered in the argument on health coverage for preventive cosmetic surgeries are:

Treatment/Procedure Cost

Cost is one of the major concerns for insurance companies. Cosmetic surgeries, including preventive surgeries, are highly expensive. For example, mastectomy and breast reduction surgeries may cost up to INR 6 lakhs in India. Skin removal surgery may cost up to INR 4 lakhs. Claim burden is taken into consideration to include the coverage under the standard health insurance policy. Hence, most of the health insurance companies provide case-by-case approval for preventive cosmetic surgeries after evaluating the medical necessity.

Medical Necessity

Medical necessity is the main consideration while debating health insurance coverage for preventive cosmetic surgery. For example, a study by Queen Mary University of London reveals that preventive mastectomy is a cost-effective breast cancer treatment for high-risk women. While these preventive procedures can improve quality of life and prevent future health complications, insurers face challenges weighing these benefits against the economic impact of broader coverage.

Ethical Concerns

The argument is not just based on financial impact but also takes ethical dimensions. If the preventive cosmetic surgery is medically necessary, only the rich can afford it without health insurance coverage. And also, some surgeries like otoplasty in children can give mental health benefits too by removing scars that give lifelong trauma.

The Road Ahead: Balanced Approach

With the rising demand for preventive cosmetic surgeries, it is important to take a balanced approach, weigh risk and reward, to come up with an expanded insurance coverage. For example, establishing the evidence of necessity, recommendations from certified specialists, an upper limit on the claim or coverage with co-pay, can be a clause to provide coverage for preventive cosmetic surgeries under proper guidelines.

At Jio Insurance Broking, you can explore various health insurance plans and their guidelines to cover the preventive cosmetic surgeries. You can make a cost-effective and informed choice with comparison shopping.

Conclusion

To conclude, the argument that health insurance plans should cover preventive cosmetic surgeries by default is complex, sitting at the intersection of cost burden, medical necessity, and ethics. As there are many studies that show preventive cosmetic surgeries improve quality of life and long-term well-being, taking a balanced approach to include the health insurance coverage with clear guidelines is crucial.