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Insurance Coverage for Correcting Deviated Septum and Crooked Nose?

I have a deviated septum and am going to get surgery in the summer but I also have a crooked nose due to breaking it. Is there any way I could get my insurance to cover both?

My doctor told me the broken part isn't too bad, but I am self conscious about it. I just want it fixed. I am active in high school sports so I have to wait until I graduate. How long would recovery be, so I can get back to working out?

Doctor Answers (11)

Ask President Obama

+3

Hi Tioga,

The physician's here have answered your question very well.  By next summer, things may be very different, you may have to ask Barak Obama whether your surgery will be covered. 

Be well.

Dr. P


Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

Insurance coverage for deviated septum

+2

Insurances do cover for a functional problem as the case with a deviated septum but not all the time. At times they require documentation with an imaging study such as a CT-Scan.

You should check with your insurance company to see if your plan covers deviated septum. Some insurance companies exclude procedures, so far I have not come across one that excludes deviated septum.

Sharon Theresa McLaughlin MD
Long Island City Plastic Surgeon

Insurance coverage for septorhinoplasty

+2

Generally, insurance will cover the functional portion of your surgery as long as your condition and the degree of nasal obstruction, and alternatives to surgery have been well documented by your surgeon. The insurance company may even elect to cover the nasal fracture portion of your procedure. If the fracture is old, it will likely be treated as a cosmetic condition and coverage is very unlikely. There are still advantages to having your nose fixed the way you want it if you are considering undergoing functional repair for breathing. First, it is one surgery and often times the septal cartilage that is being repaired can also be used to treat some of the cosmetic deficiencies of the nose.

Second, although your insurance will not cover the cosmetic portion of the nose, they will cover a great deal of the surgical center fees and the cost of the anesthesiologist. This will help to bring down the cost of having your nose fixed without any insurance coverage by a significant amount.

In terms of getting back to your work outs, I suggest being patient. Once you have committed the time, energy, and expense to having your nose fixed, you should be careful to enable the healing process to take place flawlessly. I advise against significant physical activity for about three weeks (although this will also depend on the degree of work performed on the nose) and then a gradual increase in exercise level for the next couple of weeks.

Philip S. Schoenfeld, MD
Chevy Chase Facial Plastic Surgeon
3.5 out of 5 stars 3 reviews

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Insurance coverage for deviated septum and crooked nose correction

+1

Medical Insurance has literally become a criminal scheme in which you / your parents/ employer pay a company with the understanding that IF you have a condition listed ON YOUR POLICY they and you will pay a doctor / hospital an agreed amount to correct it.

Human nature being what it is all sides cheat or push the envelope. Patients want EVERYTHING to be "covered" regardless of what they / the employer paid without any out of pocket expenses while insurance companies want to hold on to the money for as long as possible by using EVERY KIND OF PRETEXT you can imagine.

As surgeons we are caught in the middle. Each insurer has many different policies (IE MEDICAL MENUS) - each "covers" different conditions. There is NO WAY that if you paid for the "Economy" policy - you can talk your insurer to look the other way while they pay for treatments (IE dishes, in this analogy) you did not pay for. As a matter of fact, they frequently screw holders of "First Class" policies with delays. claims of pre-existing conditions, need to document "conservative care", lost photographs etc.

Your insurance is a contract between you and the insurer - not between the doctor and the insurer. As such, if you want your insurer to cover a cosmetic procedure (the nose repair) you will have to EITHER pay the surgeon out of pocket and try submitting his/her bill to the insurer afterward OR you will spend a lot of time on the phone and writing with a VERY small chance of success.

Bottom line, in almost any state of the union a Septoplasty MAY be authorized (subject to your meeting different requirements) but the nose repair would not be.

Things will NOT improve and will get worse so you may want to get it done now.

Sorry.

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 58 reviews

Insurance covers medically necessary nasal surgery

+1
Surgery for a deviated septum is typically covered by medical insurance since it is done out of medical necessity. A broken nose is sometimes covered if it is creating a breathing issue whereby both nasal bones are twisted over the upper lateral cartilages or fractured off the nasal bones causing the upper lateral cartilage to be pushed down into the airway, causing nasal obstruction called valve collapse or vestibular stenosis. It might be best to wait until you have completed playing sports, so as not to get hit in the nose. In regards to recovery after a rhinoplasty and deviated septum surgery, it is important to not work out for two weeks after surgery, and no contact sports for one month.  Insurance coverage for this type of surgery must be first documented by your physician for medical necessity and  then pre-authorization is also performed prior to the surgery. For many examples, please see the link below to our rhinoplasty photo gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 55 reviews

Rhinoplasty and septoplasty

+1

Insurance will typically cover the "reconstructive" component of the surgery which is the septoplasty, to improve your breathing. Insurance will not typically cover the "cosmetic" portion, which is the crooked nose straightening. Coverage varies greatly according to your specific health care plan, so discuss this in detail with your surgeon and insurance company to get "preauthorized". This will determine which portion and how much of the surgery they will cover for you.

Best wishes,

Dr. Bruno

William Bruno, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 136 reviews

Insurance normally covers breathing problem surgery.

+1

 It will pay for the deviation as well as the fracture repair. You can go back to moderate workout in 2-3 weeks and contact sports after 2 months.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Insurance should pay for a deviated septum, not necessarily a crooked nose

+1

Asking us if an insurance company will cover necessary surgery takes a crystal ball. First, for a deviated septum, if it is causing symptoms such as blockage and/or sinus conditions, they might requre that you try non-surgical treatments first. If that fails, they often "cover" this aspect of functional nasal surgery. How much they cover depends on your plan and if your chosen specialist participates in that specific plan.

As for your crooked nose, if it was broken many years ago, insurance companies often treat it like cosmetic surgery and will not cover treatment. Basically, if you lived with it that crooked for a number of years, it couldn't have been that much of a problem. If it is recent and you have x-ray reports as well as emergency room notes, you will have a better chance. Otherwise it will be treated as a cosmetic issue above and beyond the "covered" breathing issues.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

Check with your insurer.

+1

Today, medical insurance companies do not want to pay for anything. You need to check the company you have and see if it will cover it. Each company is different and has different requirements and hoops they make you jump through before they will pay.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.0 out of 5 stars 9 reviews

Insurance for Nasal Surgery

+1

Most insurance companies will not pay for nasal surgery performed for cosmetic reasons. Occassionally, they will cover surgery performed to correct post-traumatic deformities. Insurance will, however, pay for the portion of a rhinoplasty that is done to improve your breathing -- i.e., correcting a deviated septum (septoplasty) or reconstructing collapsed breathing passages (spreader grafts). You should check with your physician to see if he accepts insurance and whether or not you are a candidate for these types of procedures.

A septoplasty does not change the shape of the nose and is therefore considered a functional procedure as opposed to a cosmetic procedure. As such, it is a procedure that insurance should pay for (as well as facility fees and anesthesia costs). Verification of benefits and prior authorization before surgery should be obtained.

Rhinoplasty is considered a cosmetic procedure. It is very unlikely that insurance will contribute to that portion of the procedure. Even though the rhinoplasty portion of your surgery will be considered cosmetic, the functional component will be covered by your insurance and may decrease your out of pocket expense.

However, for patients with a history of prior nasal trauma and documented symptoms of nasal obstruction, a septorhinoplasty may be covered by your insurance. This terminology denotes that the surgery is performed to correct funcational problems and required reshaping the nose.

Choose a rhinoplasty surgeon who has experience in correcting both functional and cosmetic nose problems. Check to see if the physician's office can assist with your arranging your insurance pre-authorization.

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon
5.0 out of 5 stars 85 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.