Does Insurance Cover Scar Removal Procedures? What You Need to Know

Scar removal procedures can significantly improve the appearance of scars caused by injury, surgery, or skin conditions like acne. However, one common question is whether insurance will cover these treatments. Generally, insurance companies consider scar removal to be a cosmetic procedure, meaning it’s typically not covered. However, there are certain circumstances where scar removal may be considered medically necessary, making insurance coverage possible. In this guide, we’ll explore when insurance might cover scar removal, what types of treatments may qualify, and how to navigate the process with your insurance provider.

When Does Insurance Cover Scar Removal?

Insurance companies usually do not cover cosmetic procedures, and most scar removal treatments fall into this category. However, if a scar is causing functional problems or medical issues, insurance may cover the treatment. Here are some situations where insurance might pay for scar removal:

1. Scars Causing Functional Impairment

If a scar limits movement or function in an area of the body, especially after surgery, injury, or burns, it may be considered medically necessary to remove or revise the scar. For example:

• Contracture Scars: These scars, often caused by burns, can tighten the skin, restricting movement of joints and muscles. Removal of these scars might be covered if they impair mobility.
• Surgical Scars: If a surgical scar causes discomfort, restricts motion, or creates complications, scar revision surgery may be deemed necessary.

2. Painful Scars

Some scars, such as keloids or hypertrophic scars, can cause pain, tenderness, or itching. In such cases, insurance may cover treatments to reduce the scar's size or alleviate discomfort, such as steroid injections or cryotherapy.

3. Infections or Recurrent Irritation

If a scar is prone to infections or irritation, particularly if it's located in an area that experiences friction (like under the arms or on the chest), insurance may consider the treatment necessary. Recurrent infections could justify medical intervention to remove or revise the scar.

4. Psychological Distress

In some cases, if a scar causes significant emotional or psychological distress, especially in cases of disfigurement, insurance may cover treatments to help improve the scar's appearance. This is more common with large or highly visible scars, such as those on the face.

Types of Scar Removal Procedures That May Be Covered

While most scar removal treatments are cosmetic and not covered by insurance, there are some treatments that may be covered if they are deemed medically necessary. These include:

1. Scar Revision Surgery

Surgical scar revision is often used to remove or reduce the appearance of scars that are causing physical or functional problems. This procedure can involve cutting out the scar and re-stitching the skin, or using skin grafts in more severe cases. If the scar is impairing mobility or causing pain, insurance may cover the procedure.

2. Steroid Injections

Steroid injections are commonly used to flatten and reduce the size of raised scars, such as hypertrophic scars or keloids. If the scar is painful or causing discomfort, these injections may be covered under insurance.

3. Cryotherapy

Cryotherapy involves freezing the scar tissue with liquid nitrogen to reduce its size. This is often used for raised scars, such as keloids. If the scar is painful or causing recurrent infections, cryotherapy may be covered.

4. Laser Therapy

Laser therapy is a common treatment for reducing the appearance of scars. While it’s often considered cosmetic, laser therapy may be covered if it is used to treat scars that are causing functional issues, pain, or recurrent infections.

Types of Scar Removal Procedures Typically Not Covered

If the primary purpose of scar removal is cosmetic, insurance companies generally will not cover the treatment. This includes treatments aimed solely at improving the aesthetic appearance of the scar. Common procedures that are typically not covered include:

1. Laser Therapy (for Cosmetic Purposes)

Laser therapy is effective for treating scars, but if the sole purpose is to improve the cosmetic appearance of the scar, it is unlikely to be covered by insurance.

2. Microneedling

Microneedling is a minimally invasive treatment that stimulates collagen production to improve skin texture and reduce the appearance of scars. However, because it is primarily cosmetic, it is usually not covered by insurance.

3. Chemical Peels

Chemical peels help remove the outer layer of skin to reduce scarring, but they are typically considered cosmetic and are not covered by insurance unless a medical necessity is demonstrated.

4. Topical Scar Creams

Scar creams, whether over-the-counter or prescription, are generally considered cosmetic treatments and are not covered by insurance.

How to Get Insurance Coverage for Scar Removal

If you believe your scar removal procedure may qualify for insurance coverage, here are steps you can take to improve your chances of getting coverage:

1. Consult Your Doctor

The first step is to consult with a dermatologist or plastic surgeon who can assess the scar and determine if it meets the criteria for medical necessity. Your doctor will evaluate whether the scar is causing functional impairment, pain, or other medical issues that could justify insurance coverage.

2. Get Documentation

If your doctor believes the scar removal is medically necessary, they will need to provide documentation to your insurance company. This may include:

• A detailed explanation of how the scar is affecting your health (e.g., restricting movement, causing pain, or leading to infections).
• Photographs of the scar.
• A treatment plan outlining the proposed scar removal procedure.

3. Submit a Pre-Authorization Request

Many insurance companies require pre-authorization for procedures, especially those considered borderline between medical necessity and cosmetic. Your doctor’s office can help submit the necessary paperwork, including the medical justification for the procedure, to your insurance provider.

4. Follow Up with Your Insurance Provider

After submitting the pre-authorization request, follow up with your insurance company to check the status of your claim. Be prepared to provide additional information or documentation if needed.

5. Appeal a Denied Claim

If your initial request for coverage is denied, you have the right to appeal the decision. Work with your doctor to gather additional evidence or documentation supporting the medical necessity of the procedure. You may also want to review your insurance policy to ensure you are aware of all the relevant clauses regarding coverage for scar removal.

Frequently Asked Questions (FAQ)

1. Will insurance cover scar removal if it's causing me pain?
Yes, if a scar is causing pain or discomfort, such as with keloids or hypertrophic scars, treatments like steroid injections or surgical revision may be covered by insurance.

2. Are cosmetic scar removal treatments ever covered by insurance?
Cosmetic scar removal treatments are typically not covered by insurance. However, if the scar is causing functional impairment, pain, or recurrent infections, some treatments may be deemed medically necessary and covered.

3. How do I prove that scar removal is medically necessary?
You’ll need documentation from your doctor, including a description of how the scar is affecting your health, photos of the scar, and a treatment plan. Your doctor will submit this information to your insurance company for pre-authorization.

4. Is laser therapy for scar removal covered by insurance?
Laser therapy is generally considered cosmetic, but it may be covered by insurance if it is used to treat scars that cause pain, functional impairment, or recurrent infections.

5. What is a pre-authorization request, and why is it important?
A pre-authorization request is a formal submission to your insurance company that explains why a medical procedure, such as scar removal, is necessary. It is required for many procedures to ensure that they will be covered by insurance.

6. Will insurance cover scar removal if the scar is on my face?
If the scar on your face is causing functional impairment, such as restricting movement or causing psychological distress, some treatments may be covered. However, cosmetic treatments are generally not covered.

7. How much does scar removal cost if it's not covered by insurance?
Costs vary depending on the treatment type. Laser therapy can range from $200 to $3,400 per session, microneedling from $100 to $700 per session, and surgical scar revision from $1,000 to $5,000. Multiple sessions may be required for the best results.

8. Can I appeal an insurance denial for scar removal?
Yes, if your request for coverage is denied, you can appeal the decision. Work with your doctor to provide additional documentation supporting the medical necessity of the procedure.

9. Will insurance cover scar creams or silicone sheets?
Scar creams and silicone sheets are generally considered over-the-counter cosmetic treatments and are not covered by insurance.

10. Does Medicare cover scar removal procedures?
Medicare typically does not cover cosmetic scar removal procedures. However, if the scar removal is medically necessary, such as for contracture scars or scars causing pain, there may be some coverage under certain circumstances.

Understanding whether insurance covers scar removal procedures depends on whether the treatment is considered cosmetic or medically necessary. While most cosmetic treatments are not covered, insurance may cover scar removal if the scar is causing functional impairment, pain, or recurrent infections. By working closely with your doctor and providing detailed documentation to your insurance company, you can increase your chances of getting coverage for necessary scar removal procedures.