The Line Between Cosmetic v. Medically Necessary Treatment
Sometimes the line between healthcare treatment that is medically necessary vs. cosmetic isn't difficult to discern. You won't find a lot of support for the idea that a movie star's nose job is medically necessary, and thus entitled to coverage under conventional health insurance policies. But often the line between cosmetic and medically necessary procedures is more difficult to draw. Out of the Houston Chronicle comes an AP article about a teenage boy's problem with enlarged breasts. The disorder often manifests itself in the context of a genetic abnormality called Klinefelter's Syndrome. While uncommon, it occurs with enough frequency to produce an accepted protocol for medical treatment: surgery to reduce the breast size. Is this cosmetic or medically necessary? In our young man's situation, trial and appellate courts ruled in favor of the boy and his family and ordered the insurer to reimburse them for the costs of the surgery. Of related interest, the Women's Health & Cancer Rights Act of 1998 requires that group health plans cover all costs associated with reconstructive surgery following mastectomy. WHCRA illustrates the idea that some procedures initially appearing to fall on the cosmetic side of the divide may nevertheless evoke strong public opinion in support of mandated coverage. Another example of the often elusive distinction between cosmetic and medically necessary care.