Will Insurance Cover both Septoplasty and Rhinoplasty?

David Q. Santos, MD

Article by
Seattle Facial Plastic Surgeon

As a standard rule, septoplasty is performed due to inherent structural abnormalities and crookedness of the septum, which is the internal central membrane inside the nose.  Septal deviation occurs due to traumatic events and also occurs due to the inherent way it grows over time.  Deviated septum can cause obstruction of nasal breathing and this is a medical condition and therefore, as we would expect, septoplasty is covered by insurance.  There are many instances whereby trauma to the nose renders the dose deformed in such a way that the septum is crooked as well as the outside of the nose or the external dorsum.  A "nasal fracture" is a deformity of the nose that is post-traumatic and is covered by insurance.  Septoplasty with open repair of nasal fracture is a common procedure that is covered by insurance.  Specifically, this is a medical surgical procedure and is, of course, associated with a traumatic event rendering the deformity.

Cosmetic rhinoplasty is essentially a situation where the individual patient desires contour improvement of the nose to achieve better form and appearance.  As cosmetic surgeries are not deemed medically necessary, they are generally not covered by most insurance companies.

So, the key difference related to post-traumatic medical condition vs. a cosmetic, non-medical condition.

Also, there are common situations where and internal septal deviation with airway obstruction is present at the same time  as a cosmetic deformity and an overall desire by the patient to have contour and cosmetic improvements of the external nose.  A rhinoplasty and septoplasty are commonly performed together, with the septoplasty component being covered by the insurance company and the rhinoplasty covered by the patient as it is a cosmetic procedure.  The payment arangements are discussed and determined prior to surgery.