National Report — As the cosmetic revolution continues to sweep across the country, health plans are beginning to acknowledge that millions of Americans — many of whom are managed care patients — want smoother skin and sculpted waistlines. With 8.3 million women and men undergoing some form of cosmetic surgery in 2003, health plans are taking a closer look at this growing trend to better serve their members.
A small handful of health plans have ventured into this uncharted territory and are offering their members new cosmetic services that would have been unheard of five years ago. Two Blue Cross and Blue Shield plans are providing customers with discounted cosmetic services to a network of physicians, and Kaiser Permanente, making the boldest move in the industry, has opened new cosmetic centers throughout northern California that offer everything from chemical peels to facelifts for members - and non-members.
Cosmetic procedures are not the only non-traditional benefits being offered by health plans. Many insurers now routinely cover chiropractic care, and alternative medicine is quickly becoming a covered benefit. Other health plans are starting to offer discounts on LASIK surgery, gym memberships and subscriptions to health magazines.Consultant Patricia Burgess says that offering these "value-added services" marks the dawn of a new era in managed care. "Many health plans are running out of ways to compete, and lifestyle benefits are one of the few areas still remaining that can differentiate a managed care organization from its competitor down the street," explains Ms. Burgess, of Atlanta-based Cosmetic Surgery Consultants and author of the book "Cosmetic Surgery Without Fear."
For now, health plans are cautiously entering the prosperous field of cosmetic services - an area of medicine that has been shunned by insurers for decades. But with demand for cosmetic procedures skyrocketing, health plans are taking another look at this growing market.
"Managed care organizations are doing this to be more member friendly," comments Ms. Burgess, formerly with U.S. Healthcare. "Health plans have a vested interest in doing this because they want to direct members to qualified doctors to prevent unsatisfactory procedures."
Ms. Burgess adds that many health plans are unknowingly paying for complications resulting from cosmetic surgery. As an example, she explains what happens when a rhinoplasty is unsuccessful. "If a CPT code comes through as a nasal valve collapse, the doctor or patient will probably not say it was the result of poor cosmetic surgery. It's just going to come through as a reconstructive cost to the company. If health plans can direct people to good-quality doctors to begin with, they will minimize the cost of corrective surgeries."
Cosmetic ventures One of the earliest experiments to offer discounts on cosmetic services failed, however. UnitedHealthcare of Georgia offered discounts to members under a pilot project started in 1999. Plan administrators decided to reduce complications by developing a network of nearly 20 cosmetic surgeons who met certain quality standards. Under the program, United's members received discounted consultation visits to Burgess' company, which provides advice and guides people to a network of cosmetic surgeons and dermatologists who meet national quality standards.
While United never supported the program with an extensive marketing campaign, word still spread quickly to members. But after a few months, the program lost support when executive leadership changed hands at the company.
Undeterred by UnitedHealthcare's failed attempt, BlueCross and BlueShield of North Carolina kicked off a program in October 2001 to provide discounted cosmetic services. Eight cosmetic surgery practices participate in the network, and more than 2,200 members have called a toll-free referral line since the program's inception. The practices offer a flat 15 percent discount on surgery costs; anesthesia and facility expenses are billed at the full amount.
Another experiment with discounted cosmetic services provided by BlueCross and BlueShield of South Carolina enlists two established cosmetic surgery practices to provide discounted cosmetic procedures to its 1.4 million members. The discounts will average about 20 percent for eight common procedures.
BlueCross BlueShield of South Carolina also signed up Charleston Plastic Surgery, headed by Tracy Harvey, M.D., and Richard Hagerty, M.D. The health plan has not determined how many other practices it might add, comments Rick Gallion, director of complementary health care.