Elective Procedures


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Medical breakthroughs occur every day. Some of these are lifesaving, paradigm-shifting revelations that change the way we live, and some just improve our lifestyle. An angioplasty, for example, may greatly lengthen your life span and improve your quality of life, but it might not be immediately required in order for you to live. Cosmetic surgery and hair plugs might improve our chances of getting a date or a job, but in most cases, you'd still be able to live a long, fulfilling life without it. These are all good examples of what is referred to as an elective procedure.

In general, elective procedures are those deemed, by your doctor or your insurance provider, as not medically necessary. This rather vague terminology has a specific definition of clinically appropriate medical services that a practitioner would provide a patient in order to prevent, evaluate, diagnose, or treat an illness, injury, or disease. Medically necessary services also must be generally accepted in the medical community and can't be more expensive than a comparable alternative. All elective procedures are planned, nonemergency care designed to improve your quality of life physically and psychologically. They can be performed on an inpatient or outpatient basis, and insurance coverage is usually minimal. No matter your motivation, elective procedures are going to cost you.

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Types of Elective Procedures

There are as many different kinds of elective procedures as there are bones in the body. They can include:

When we hear the word "elective," we probably think of a strictly superficial process. While it's true that the most popular types of elective procedures are plastic surgery, laser vision correction and hair replacement, there's still a large segment of elective procedures that have nothing to do with vanity.

Angioplasty, for example, is a procedure in which a balloon is used to open a blocked coronary artery in order to improve the flow of blood to the heart. It's considered elective, even though it can help prevent a person's chance of a future heart attack. Hip replacement is another popular procedure that's used to help patients with poor joints regain their mobility. However, because this procedure isn't performed in order to save the patient's life, it's not considered medically necessary.

Will insurance cover elective procedures?

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It might seem odd to lump vasectomies and liposuction together with angioplasties and cataract removal. As long as the procedure is deemed immediately medically unnecessary, regardless of the benefit, it will be classified as elective, thus releasing your insurer from an obligation to offer coverage, or greatly reducing the amount of coverage. Generally, HMO plans don't cover elective procedures. PPO plans may cover certain elective procedures, such as an angioplasty, with you paying a percentage of the bill and the co-pay. These procedures vary from plan to plan, so be sure you are aware of what is covered in your plan before scheduling a procedure with your doctor. Finally, in a fee-for-service plan, your high premiums and up-front costs are rewarded with more coverage for elective procedures. However, you should still check to be sure your elective surgery is included.

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There are a few key exceptions, including breast reconstruction following a mastectomy, rhinoplasty to correct severe breathing restrictions, reconstructive surgery after a severe accident and bariatric surgery if your weight is an immediate danger to your health.

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For more information on elective procedures, health insurance and related topics, check out the links on the next page.

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Sources

  • Angioplasty.org: History Center http://www.ptca.org/nv/history.html
  • Elective Procedures.Org http://www.electiveprocedures.org/seminar/default.aspx
  • Find Articles: Liposuction Ranks as Top Cosmetic Procedure http://findarticles.com/p/articles/mi_m0BJI/is_8_31/ai_76758565
  • Mayo Clinic: Hip Replacement, Relieve Pain and Improve Mobility http://www.mayoclinic.com/health/hip-replacement/AR00028
  • National Heart Lung & Blood Institute: Facts About Angioplasty http://www.nhlbi.nih.gov/health/public/heart/mi/angioplasty_dci.htm
  • Your Health Information Center: Elective Procedures http://www.yourhealthinfocenter.com/information.php