CosmetAssure

Coverage Requirements

coverage-requirements

Patients must be enrolled prior to surgery. If a patient has a complication within the first 45 days following their surgery, CosmetAssure will cover the cost of treating the complication within the Maximum Limits.

CosmetAssure coverage is provided to all participating surgeon’s patients having one or more Covered Procedures. CosmetAssure will pay usual and customary medical expenses incurred by the patient, up to the applicable Maximum Limits (shown below) if the following requirements are met:

  • Surgical Event is registered in CosmetAssure Member Services (CMS)
  • Covered Complication (listed below) occurs within 45 days of the original Surgical Event with the exception of Capsular Contracture*** which must occur within 18 months of a primary breast augmentation
  • Treatment of Covered Complication(s) takes place at a Hospital, ER or other Accredited Facility*

Covered Complications

Cardiopulmonary Related

  • Arrhythmia
  • Cardiac Arrest
  • Deep Vein Thrombosis
  • Fluid Overload
  • Hypoxia
  • Myocardial Infarction
  • Pulmonary Dysfunction
  • Pulmonary Embolus
  • Rule Out Deep Vein Thrombosis
  • Rule Out Myocardial Infarction
  • Rule Out Pulmonary Embolus
  • Shock

Surgery Related

  • Capsular Contracture***
  • Hematoma**
  • Hemorrhage
  • Infection**
  • Rule Out Infection**

 Anesthesia Related

  • Severe Hypotension (systolic BP equal to or less than 80, three hours after the Covered Procedure)
  • Severe Hypertension (systolic BP equal to or greater than 200 or diastolic BP equal to or greater than 100, three hours after the Covered Procedure.)

*Accreditation requirements include JCAHO, AAAHC, AAAASF or Medicare approval.

**Infections and hematomas that are related to the Covered Procedure.

*** Capsular Contracture covered if diagnosed within 18 months and treatment completed within 24 months from date of primary breast augmentation.

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