Cosmetic surgery coverage
A health insurance plan that covers breast implants, Botox and body sculpture?
Not exactly. But growing numbers of health insurers are starting to offer sizable discounts on cosmetic surgery to entice new members and retain existing ones.
There’s no doubt that many Americans want medical help in looking better. They spent about $9 billion in 2001 on plastic surgery and cosmetic procedures, according to the American Society for Aesthetic Plastic Surgery. About 8.5 million procedures, ranging from thigh lifts to cheek implants to breast reductions, were performed that year, an increase of 48% over 2000. (Statistics for 2002 are not yet available.)
Even Kaiser Permanente is capitalizing on the public’s zeal for cosmetic surgery. The nonprofit health plan has created about two dozen for-profit clinics in Northern California to do plastic surgery and procedures such as facial chemical peels. The services aren’t covered by Kaiser insurance, so patients must pay fees similar to the usual market rates. Still in their infancy, the centers already have generated $20 million in revenue for the Oakland-based HMO giant.
The move is part of a larger push by health insurers to be more responsive to corporate customers whose workers are demanding health plans that offer more than just basic medical and preventive care. That has prompted some insurers to offer special health plans that cover popular alternative medical treatments, such as acupuncture, and laser eye surgery for vision correction.
Because many health plans offer comparable medical benefits and preventive services these days, insurers are looking for other ways to sway consumers.
“For the most part, [health plans] all offer those core benefits, and after that, what’s left are the bells and whistles,” says Patricia Burgess, a health care consultant and founder of Safecosmeticsurgery.com, which screens plastic surgeons for health care plans and individuals.
Blue Cross and Blue Shield of South Carolina, for example, is offering 20% discounts for tummy tucks, liposuction, nose reshaping, breast enhancements and lifts, and other cosmetic procedures. The caveat: The procedures must be performed at two plastic surgery centers that the insurer contracts with.
The South Carolina insurer believes the discount program helps discourage some members from switching to rival plans, said Rick Gallion, director of complementary health care. “When they compare us and the price is almost the same, they say they might as well get the [plan with] the discounts.”
Like some other insurers across the country, the South Carolina plan a few years ago began offering discounts to its 1.4 million subscribers on Lasik eye surgery, massage therapy, chiropractic services and even aromatherapy.
So far, the reaction to the fledgling cosmetic surgery program has been tepid.
Plastic Surgery Associates of Greenville, S.C., which is part of the Blue Cross plan, says it has received lots of calls and e-mail inquiries since the optional plan was unveiled last fall. “Some [people] get confused and think the insurance is paying,” says office manager Debby Misenheimer. But only a few have actually come in, she says. The most popular inquiry: breast augmentation.
A tepid response
Neither the plastic surgery clinic nor the South Carolina plan will disclose the cost of the procedures, but the average fee plastic surgeons charge for breast implants is about $3,000, plus the cost of anesthesia and the operating room, according to the American Society of Plastic Surgeons. At comparable rates, that could mean a savings of at least $600 for Blue Cross and Blue Shield subscribers.
BCBS’ Gallion, however, isn’t discouraged by the lackluster response. Although the discounts only began last fall, he said, the company’s Web site has received several thousand “hits” from people seeking information about the program. He hopes the program eventually will be as popular as the Lasik eye surgery discounts the plan has offered since 1999; about 4,000 members have participated in that program, which reduces fees by about half.
The cosmetic surgery discount plans don’t appear to have caught on yet among Southern California insurers. Ken Ferber, a spokesman for Wellpoint, a Thousand Oaks-based health insurer, thinks he knows why.
“Can you imagine a California company covering body sculpting? We’d go broke in a week,” jokes Ferber, whose company is the parent firm of Blue Cross of California.
But some insurers say that there’s little to lose by offering such programs. The health plans recruit plastic or cosmetic surgeons to join the program, enticing them with the prospect of higher volumes of patients in exchange for discounted fees. And the insurer hopes to get more customers.
Kaiser executives say the HMO decided to open cosmetic surgery centers because many patients were asking about such services. Kaiser has many members who have been in the HMO for years and see only Kaiser-affiliated doctors. Such members are familiar with the plan and would prefer not to have to go to outside doctors for cosmetic surgery, said Carol Moretti, senior venture manager of cosmetic services at Kaiser Permanente Northern California.
In addition, she says, Kaiser doctors sometimes would see patients complaining of complications after being treated by outside cosmetic surgeons. These patients required treatment for which Kaiser had to foot the bill. “If they were bleeding, we’d have to take care of it. We said, why are we only getting involved with something that’s messed up? We’re hoping we’d be doing it right the first time.”
The clinics, called Kaiser Permanente’s Centers for Cosmetic Services, primarily treat Kaiser members, but see nonmembers, too. Fees are typical of current market rates. The surgery is performed in outpatient centers, and patients must pay out of pocket for the services. Kaiser officials would not discuss rate information.
“We don’t want to be the lowest- or highest-cost provider,” Moretti said. The most popular treatments: Botox, breast implants, face peels and liposuction.
Burgess, the consultant, thinks the next big area for insurers will be so-called “anti-aging” treatments, ranging from the human growth hormone to natural supplements.
