Is Microtia Surgery Covered by Insurance? BY DR. ARTURO BONILLA
The short answer is YES!
MICROTIA SURGERY IS NOT COSMETIC SURGERY. It is very common for an insurance company to assume that an ear deformity is nothing more than a protruding ear, otherwise known as a "lop-ear deformity" as shown in this picture. A patient with protruding ears has normal hearing and the concern is usually based on the appearance. Many feel that the surgery to correct a lop-ear deformity should be covered by insurance since it can cause psychological issues, such as teasing in school, etc.... Nevertheless, insurance companies in general will not cover the "Otoplasty" procedure to correct this lop-ear deformity.
On the other hand, Microtia and Atresia surgery is not considered cosmetic surgery. Instead, it is functional, reconstructive surgery. The purpose of the surgeries are to correct the congenital ear malformation as well as the hearing loss that is associated with moderate to severe conductive hearing loss.
Our office takes charge of submitting all of the pre-authorizations for the surgical procedures. We will send pictures to the insurance company so that they fully understand that this is a congenital ear malformation.
We will also submit hearing tests (audiograms) to your insurance company to show that in addition to a congenital ear malformation, there is also associated moderate to severe conductive hearing loss.
If Dr. Bonilla is out-of-network with your health insurance, his office works with your insurance company to agree on an "in-network" exception. This means that instead of the patients having to pay a very large out-of-network fee, a negotiated contract is agreed upon between Dr. Bonilla and your insurance company so that your responsibility is minimal. In this way, microtia surgery is very affordable and you can spend all of your time and energy caring for your child.