Is Plastic Surgery After Mohs Covered by Insurance?

Navigating Insurance Coverage for Plastic Surgery After Mohs Surgery

Mohs surgery is a precise, specialized technique used to treat certain types of skin cancer.

This procedure, named after Dr. Frederic Mohs who developed it in the 1930s, involves surgically removing thin layers of skin and examining them under a microscope to ensure all cancerous cells are removed.

Due to its meticulous nature, Mohs surgery achieves exceptionally high cure rates while minimizing damage to healthy tissue surrounding the cancer.

While Mohs surgery itself is usually covered by insurance when medically necessary, patients may still face financial questions regarding plastic surgery after Mohs

What Is Mohs Surgery and Why Is It Performed?

Mohs surgery, also known as Mohs micrographic surgery, is recognized as the most effective technique for treating common skin cancers such as basal cell carcinoma and squamous cell carcinoma. It offers cure rates up to 99% for cancers that have not been treated previously.

The key advantage of Mohs surgery lies in its precision. The physician serves as surgeon, pathologist, and reconstructive surgeon. After removing a thin layer of tissue, the doctor meticulously maps, colors, and microscopically analyzes it to discern if any cancer cells remain.

If found, the surgeon pinpoints their exact location and excises deeper tissue only from that specific area. This process continues layer-by-layer until no cancer cells are detected.

This controlled, methodical approach allows complete removal of the cancer while maximizing the preservation of healthy tissue. Consequently, Mohs surgery is often used to treat cancers on cosmetically or functionally vital areas of the face, ears, hands, feet, or genitals.

Why Might Plastic Surgery Be Necessary After Mohs?

Despite its tissue-sparing properties, the removal of cancerous tissue can still leave defects in form and function. Plastic surgery after Mohs serves to restore aesthetic appearance and functional abilities.

Common reconstructive techniques include:

• Skin grafts: Transplanting skin from elsewhere on the body to cover surgical wounds.
• Flap procedures: Transferring nearby skin with intact blood supply to reconstruct complex defects.

Plastic surgery repairs are customized to each patient’s unique circumstances.

The optimal approach depends on factors like the size and location of the wound, available donor sites, and the patient’s needs and goals. Consulting a plastic surgeon specializing in reconstructive procedures ensures the best outcome.

Does Insurance Cover Mohs Surgery for Skin Cancer?

Insurance policies generally recognize Mohs surgery as a standard, medically necessary treatment for common skin cancers like basal cell carcinoma and squamous cell carcinoma. Coverage details depend partially on your specific plan.

It’s important to understand your policy’s skin cancer coverage details, including any prior authorization requirements. Your doctor can provide supporting documentation if the insurance company requests justification for Mohs surgery over other treatments.

When Will Insurance Cover Plastic Surgery After Mohs?

Insurance coverage for reconstructive plastic surgery hinges on the distinction between cosmetic and reconstructive procedures.

Cosmetic enhancements to improve appearance typically are not covered, whereas reconstructive surgeries to restore function and normal appearance may be covered.

Establishing medical necessity also plays a key role in obtaining coverage after Mohs surgery. Insurance providers require proof that reconstructive procedures are essential for maintaining quality of life and well-being.

Documentation of medical necessity may include evidence that plastic surgery will:

• Restore facial symmetry
• Improve vision obstructed by tissue deficits
• Enable normal eating, swallowing, or speech
• Reduce risk of infection due to open wounds

Carefully consulting with your insurance company helps clarify requirements in your specific situation.

Tips for Navigating Insurance Policies

Understanding health insurance plans can be confusing. Here are some tips for navigating coverage for plastic surgery after Mohs:

• Read plans closely, noting coverage details, documentation requirements, and exclusions.
• Ask questions if unclear on policy provisions. Maintain open communication with your insurance company.
• Have your doctor provide supporting documentation explaining the medical necessity of reconstructive procedures.
• Keep organized records of insurance correspondence should you need to appeal a coverage denial.

How to Appeal if Plastic Surgery is Denied

If your insurance denies coverage for plastic surgery after Mohs, you can appeal the decision by:

1. Reviewing the denial letter and policy basis for the denial.
2. Gathering medical evidence of surgical necessity from your doctor.
3. Drafting an appeal letter detailing why you believe the procedure should be covered.
4. Formally submitting the appeal along with supporting documentation.
5. Following up persistently with your insurance company throughout the appeals process.

Seeking assistance from a patient advocate or legal professional can also help navigate appeals. Don’t give up easily—make your case!

Alternative Financing Options

If appealing an insurance denial is unsuccessful, alternative options exist for funding plastic surgery after Mohs:

• Ask if your surgeon offers payment plans to spread out costs over time.
• Apply for a medical credit card with flexible financing terms.
• Use Health Savings or Flexible Spending Account funds.
• Explore crowdfunding resources or apply for grants supporting reconstructive surgery costs.

Thoroughly researching costs and financing alternatives helps patients prepare for surgery, even if insurance coverage falls through.

The Takeaway

While Mohs surgery itself is typically covered for skin cancer treatment, insurance coverage for subsequent reconstructive plastic surgery depends on many factors.

Navigating policy limitations and denials requires tenacity and creativity. Working closely with your treatment team and insurance providers while exploring alternative funding options equips patients to surmount potential financial barriers to achieving optimal outcomes after Mohs surgery.