“Why they chose that wording, I have no idea,” Fuqua says. “Non-standard” procedures—tummy tucks and body lifts—carry a higher premium than “standard” ones like lipo or facelifts, because they have a higher rate of complication. Abdominoplasties, or tummy tucks, carry the greatest statistical risk—about four times the complication rate of other procedures, at four percent.
What CosmetAssure does not cover include revision surgeries—even those directly caused by a complication—nor dissatisfaction. You can argue that your facelift scar is bigger than you thought it would be until you’re blue in the facelift scar, but insurance is unlikely to care. The capital-A Assurance the company provides comes not from knowing that your self-investment is completely protected but that, in the event of a catastrophic bodily reaction within a month and a half of your procedure, you probably won’t pay as much money as you otherwise would. And isn’t that comforting?
CosmetAssure was conceived in Birmingham, Alabama, by the plastic surgeon James Grotting and an attorney named James Sedgwick, who was the general counsel and then president of the United Investors Life Insurance Company until he retired in 1998. Grotting had been trying for years to solve a critical lack of insurance coverage for plastic surgery complications. A patient of his had a successful procedure, but developed a cardiac arrhythmia during her recovery. “I found myself in the hospital administrator‘s office, asking him to please write off the huge unanticipated cost associated with monitoring, even for one night in the cardiac intensive care unit,” Dr. Grotting says.
He and Sedgwick came up with a program that they shopped around to insurance agencies. It was a tough sell but in 2003 they were finally able to secure American International Group as their underwriter, and Palomar Insurance as their broker. In 2016, a feeling of stagnancy prompted Grotting and Sedgwick to change brokers, and CosmetAssure moved beneath the umbrella of USI, one of the world’s largest brokerages. They negotiated a separation, but Palomar held on to CosmetAssure’s skeleton—its website, its policies—and created a competitive product, Aesthetisure. “This was unfortunate, from our standpoint, as we felt that it was against the spirit of the separation.” Dr. Grotting says, but there was no legal precedent to fight it. Like CosmetAssure, Aesthetisure insures providers, not specific patients or procedures. Unlike CosmetAssure, it’s available to surgeons who practice outside either Society, and is a much smaller program, enrolling about 100 surgeons nationwide.
“As long as you’re board-certified in a field of surgery that is cosmetic or aesthetic or plastic in nature, we will provide you coverage,” says Sonya Berryman, an executive vice president at Palomar Insurance Corporation, Aesthetisure’s parent company. The cost comes out to either $139 or $217 depending on the procedure, which is passed on directly to the patient, who pays the physician, who pays back Aesthetisure.
Complication insurance is marketed as little more than a balm for nervous patients, but a selling point for practices. “Plastic surgery has become very commonplace, and there’s a lot of competition to get those patients into your practice,” Berryman sagely notes. “This is just an additional tool that you have.”
The American Society of Plastic Surgeons has endorsed CosmetAssure since 2004, and last year the insurance provider sponsored the Society’s 2023 Procedural Statistics Report. “ASPS chooses [to partner with] products that will enhance the physician’s practice and support patients in their plastic surgery journey,” says Steven Williams, MD, the president of ASPS. “Complication insurance is one of those products.”
Because the vast majority of complications occur about a month after the procedure, complication coverage lasts 45 days starting the day you leave the operating room. One exception is a complication called capsular contracture, which occurs when tough scar tissue forms around a breast implant; these cases are slower to develop, and are covered for 18 months following breast augmentation surgery. With the latest silicone-gel implants used in the majority of American breast augmentations, the risk of capsular contracture is between about 12 and 19 percent at 10 years. Complication insurance will cover costs related to the removal of the breast implant if a capsular contracture is diagnosed within that first year and a half (and operated on within two years) but is yet unable to cover a revisional surgery. “Our goal is to cover revisional,” Fuqua says of these particular cases. “We’re just in the process of trying to figure out what that risk really looks like.”
