Is otoplasty covered by insurance? The grey zone and who determines coverage

Unfortunately, this is not a straightforward answer. More often than not, otoplasty is considered a cosmetic, elective procedure and is therefore not covered by insurance. However, there are instances were insurance may pay for the procedure based on its reasoning.

There are grey areas when it comes to health insurance coverage – there are no fixed rules as to when or if a health insurance company will cover something. The rules change over time and from one company to another. Some may cover a particular procedure while others won’t. The decision is ultimately made by the insurance company and not your surgeon.

If the ear being addressed is considered to be a congenital deformity, it’s more likely that it will be covered by insurance. This is more likely the case in young children.