Insurance Coverage for Correcting Deviated Septum and Crooked Nose?

Question

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?

Philip S. Schoenfeld, MD, FACS · Answer

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.

Eric M. Joseph, MD · Answer

If you have a deviated nasal septum and a crooked nasal appearance, the expertise of your surgeon may be one of the most important factors for achieving a desired result. Consider consulting with several rhinoplasty specialists near you, so you could see what might be best. Thank you. Dr Joseph

Andrew Miller, MD · Answer

If your nose used to be perfectly straight, then you have a great chance of making it straight again. It is best to do the septoplasty and nasal straightening together, and if the crookedness is due to a nasal fracture, then insurance usually pays for both of them.

Eric J. Yavrouian, MD · Answer

In general, insurance covers the functional portion of your nasal surgery including correcting a septal deviation, nasal valve repair and turbinate reduction if needed. They can also cover the repair of nasal fractures. However, the insurance does not cover any cosmetic portion of nasal surgery which includes straightening a nose.
It is still to your advantage to do address cosmetic concerns at the time of your functional nasal surgery for several reasons. First, it does not add much time to your recovery. Secondly, the septal cartilage that is addressed during your septoplasty is useful in acheiving your desired cosmetic changes. Thirdly, insurance coverage of the functional portion of the surgery helps drive the cost down for any additional cosmetic surgery as the majority of the anesthesia and facility fees are paid by the insurance and any additional cosmetic surgery time is less costly.

Deepak Raj Dugar, MD · Answer

Hello,The general rule for rhinoplasty procedures and insurance is that insurance will only cover if it is a functional issues. This means that your breathing is obstructed in some way and needs to be fixed to better your quality of life. You will have to make sure your insurance plan even offers the possibility of covering a septoplasty, and then you have to send in your documentation to verify how bad it is. As to your workout question, I advice my patients to wait 6 weeks before starting to work out again. All the best, Deepak Dugar, MDScarless Rhinoplasty ExpertBeverly Hills, CA 90210

Rady Rahban, MD, FACS · Answer

Very common question is will my insurance pay for my surgeryThis has lots of elements and is not straight forward.  First it depends on your plan and your benefits.  Call you insurance company to see what they cover.  Next at most your insurance will pay for things the cause a functional problem like breathing issues.  A deviated septum on its own while it may make your nose crooked does not necessarily lead to breathing issues.  You will need a full work up with perhaps a CT scan and then your surgeon can determine the extent of your problems and submit it to your insuranceGood LuckDr Rahban

Sirius K. Yoo, MD · Answer

Insurance will generally cover surgery to correct problems with the function of the nose such as breathing issues.  A crooked nose may contribute to difficulty breathing depending on the location of the deviation.  Sometimes correction will result in a better looking nose as a result, but not always.  Surgery with the intent to change the shape of the nose to improve the appearance is cosmetic and not covered by insurance and would be an out of pocket expense.  These procedures are commonly combined and performed at the same time.  Speak to a rhinoplasty expert who also specializes in functional work to be evaluated and collaborate on a plan for your nose.

Richard J. Bruneteau, MD · Answer

It’s not unreasonable to seek prior authorization from
insurance carriers for both rhinoplasty and septoplasty performed simultaneously. Post traumatic deformities of the nose and
deviated nasal septum’s can both be caused by trauma and both problems may
therefore be covered by insurance.Septoplasty
is often covered by insurance, especially when nasal airway obstruction is
present.Under these circumstances, this
represents a functional problem. Rarely
insurance covers reconstructive rhinoplasty as a restorative procedure.In some
cases, insurance carriers approve septoplasty, while denying benefits for
rhinoplasty. In this situation, nothing is lost by running the rhinoplasty
through insurance. For this reason,
there’s no reason not to seek prior authorization for both procedures, if
there’s any question about insurance coverage.

Jerome Edelstein, MD · Answer

Insurance generally covers procedures that are to improve function and your health, but not those that are just for aesthetic purposes. You should ask your provider directly.

Philip J. Miller, MD, FACS · Answer

Breathing problems are caused by a number of structural changes within the nose. The septum (the partition between the right and left nostril) can be shifted, or deviated from one side to the other narrowing the nasal passage. Furthermore, in the case of a broken nose, the nasal bones may be pushed in words and narrowing the nasal passageway. Finally, there are "valves" and "warming and filtering organs" within the nose that may be impaired and require reconstruction.All of these procedures are typically covered by insurance however different insurance companies require different preliminary or prerequisite treatments or tests before they will agree to pay for the procedure.  By all means seek a consultation and ask your insurance representative if they cover the procedure that your surgeon recommends.

Lewis Albert Andres, MD · Answer

Hello! Thank you for your question! Surgical procedures for aesthetic 
purposes, to improve appearance, are not covered by insurance. 
Typically, these as well as complications resulting from such procedures
 are the responsibility of the patient. Procedures that are meant to 
correct functional issues and those which cause health-related issues 
should be covered by your insurance as a medical necessity, with proper 
examination and documentation.  Some insurance plans have exclusion 
criteria for certain procedures.  Also, it is an obligation of the 
surgeon not to attempt to authorize purely cosmetic procedures through 
insurance.  The septoplasty, but not the rhinoplasty, may get covered.Discuss your issues and 
complaints with a board-certified plastic surgeon to discuss these as 
well as to examine and assist you in deciding which procedure(s) will be
 the best for you. A discussion of the advantages and disadvantages will
 take place along with the risks and benefits. Insurance companies will 
vary on coverage and is always reasonable to discuss your issues with 
your surgeon and primary care. It would behoove you to get as much 
information as possible and even call your insurance yourself. 
Certainly, pay in advance prior to your surgical procedure and options 
such as financing are available if you qualify. Hope that this helps! 
 Best wishes!

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