When you go to your doctor or dentist, you might hear them talk about something being “cosmetic” as opposed to “medically necessary.” But is this just a matter of opinion, or is there a real difference between the two? How can you tell the difference yourself, and save a trip to the doctor?
Generally, the assumption is that cosmetic procedures aren’t going to keep you alive or healthier, but might make you feel more confident, or help conceal some minor imperfection. For example, a dermatologist might remove moles not because they are at risk for skin cancer, but simply because you don’t like where they are located or how they look. Likewise, your dentist might offer you invisible braces, as opposed to metal ones, so they aren’t as obvious when you smile, but still help straighten your teeth. Even straightening your teeth, for that matter, might be more a matter of cosmetics than of improving your oral health.
On the other hand, cosmetic treatment is not always a simple matter of vanity. Consider burn victims who undergo reconstructive plastic surgery. They aren’t just trying to look good, they are seeking help in order to function normally and get back to living their lives. That surgery may sound cosmetic — “plastic surgery” is often used interchangeably with “cosmetic surgery” by many people — but the goals and needs of the patients are very much medical in nature.
So what difference does this all make to you, the patient? After all, either way you’ll be making appointments, going to the doctor, possibly getting prescriptions and generally having your body looked after by professionals. Why should you give a second thought to whether you are looking for cosmetic solutions to your complaints?
Paying for Cosmetics and Healthcare
No one is more interested in whether your care is purely cosmetic or medically necessary than insurers. Your insurance company will likely describe certain procedures as “elective,” meaning that you chose to get the treatment, rather than requiring it for your health. In simpler terms, this is a judgement of whether a procedure or treatment is something you just want, or something you truly need. And just as distinguishing wants vs needs is good for your personal budget, it is a way health insurance companies decide whether to help pay for care and how much to pay.
Elective procedures can range from a consultation with a specialist to invasive surgery; even having a doctor’s recommendation or referral doesn’t guarantee that insurers won’t consider something as elective.
For instance, if you tell your doctor that you are unhappy with a skin blemish, he may order lab work to determine whether the blemish could be cancerous. If not, you can still be referred to a dermatologist to have it removed, but it would be classified as an elective surgery, because there is no real threat to your health.
If your motivation for seeking any type of care is anything other than a concern for your health, there is a good chance your insurer will treat the services you receive as cosmetic and may pay little to nothing as a result. However, that does not automatically mean that all cosmetic treatment is unnecessary, unhelpful, or even without very real medical benefits.
The Value of Cosmetic Treatments
Insurers are less likely to quibble about something being elective if you get it in the emergency room; the whole point of this department, after all, is giving life-saving treatment to critical patients. Part of the distinction between cosmetic services and necessary medical care is the value of the treatment to the patient’s overall health and wellbeing. However, this is not as straightforward as it might seem — or as insurers often try to pass it off.
Dental implants are a perfect example. On the one hand, if you’ve lost your own teeth for any reason, you still need some kind of replacement in order to eat and lead a healthy life. Unlike dentures, however, dental implants require surgery, as they replace the root — the part of the tooth below the gumline — as opposed to just the crown, or the part of the tooth you see and which does the actual chewing of your food.
The distinction is not purely cosmetic. While implants feel more comfortable and are less likely to come loose or bother patients the way dentures do, they also provide very tangible benefits to a person’s overall jaw strength and dental health in ways that dentures simply don’t. Unfortunately, for insurance purposes, implants are often not covered as an elective or cosmetic procedure.
Cosmetics May Succeed Where Medications Fail
Compare dental implants with Botox injections. You might be familiar with Botox because you’ve learned to associate it with celebrities getting cosmetic surgeries, or people generally trying to look younger.
However, recent research has shown that certain Botox injections, when done correctly, can provide significant relief for sufferers of migraines. While the technique is similar whether it is cosmetic or medical, Botox injections for the treatment of migraines are decisively medical, rather than superficial. In the same way that someone with chronic back pain is able to get prescription painkillers, someone with a history of chronic migraines might seek Botox therapy to mitigate their pain.
In this case, unlike dental implants, FDA approval has cleared the way for insurers to cover Botox injections for migraine sufferers. That means insurers may cover the procedure; unfortunately, they may require a more rigorous qualification and approval process, which could necessitate extra doctor’s visits, screening, and paperwork for patients seeking relief.
Blurring the Line Between Cosmetic and Life-Saving
If you are confused at this point, you are not alone. The difference between a cosmetic treatment and one deemed medically necessary can seem arbitrary, if not outright backwards, depending on what you are trying to treat, and what options are available to you. Despite common associations — like plastic surgery and Botox with vanity or age-fighting — the truth is much more complex.
Fortunately, the system is slowly catching up, and more insurers and doctors alike are recognizing the connection between how patients feel, and their overall wellness. As researchers find more medical uses for formerly cosmetic procedures, and patients find new confidence and relief by pursuing treatment once considered elective, the whole healthcare system is giving more people more options to lead happy, healthy lives.
Image Source: U.S. Navy