Sinus Blockage, Headache From Injury to Nose. Rhinoplasty and Insurance? (photo)
- Asked by LadyLonghorn in Austin, TX
- 10 months ago
I'm a 20 y.o. fem. w/ a bent septum, and my nose is tilted from being hit in the face with a softball. It causes sinus blockage and headaches. I'm wanting to get this straightened out to clear congestion. I was prescribed flonase by a doctor that was seeing this problem, but it doesn't help. However, I also would like my nose to be straighter and a little smaller at the tip. I know my insurance does cover problems like the first I mentioned, but will it cover even a portion I add on the latter?
Combined functional and cosmetic rhinoplasty
dear fellow austinite:
your photos are quite helpful. i have very little doubt that you have a severly deviated septum based on the photos. i have never seen a nose with that degree of bowing and asymmetery that did not have siginficant septal deviation - you insurance would likely pay for the correction of that. addtionally, i would be willing to bet that you have some internal narrowing at least on one side - the correction for that is a procedure i do frequently and i believe insurance would likely pay for that as well. that leaves the hump (if you want it corrected - you did not mention it but many people desire this) and the smaller tip - those would likely fall under the cosmetic umbrella. but overall because the procedure for your septum and the internal narrowing would be covered by insurance and overlap with a rhinoplasty your out of pocket expenses would likely be a fair amount less than if you had to pay for 100% of a cosemtic rhinoplasty.
would love to help you given that we are in the same town - i deal with patietns like you several times a week if not daily
office number is 512-324-8320
website has a lot of great info and examples - search for
"austinfaceandnose" or dr adam bryce wienfeld - you'll find it
Sinus blockage, headache, rhinoplasty and insurance.
Thank you for your questions and your photos. This is an area that can get a little tricky as far as your insurance is concerned. First of all you must have a complete evaluation of your nose both externally and more importantly internally. Any problems that are causing you difficulty breathing should be covered by your insurance. The external or esthetic appearance is not covered by your insurance and will have to be paid by you. Another factor you should be aware of is the cost of the operating room ether in a hospital or a surgicenter. Be sure you understand how much your insurance plan will cover when you combine both a functional operation with an esthetic nasal operation to avoid any unpleasant surprises after surgery. Best of luck.
An internal exam would be necessary to determine exactly what needs to be done as septal deflection or deviation is but one of many causes. Also, you must have (usually unilateral) obstructive breathing problems related to an anatomic cause for insurance to cover this. The external components could be addressed with a rhinoplasty at the same time. Insurance will not pay for this portion. Kenneth Hughes, MD Los Angeles, CA
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Septorhinoplasty will provide aesthetics and function
Dear Ladylonghorn, A septorhinoplasty is a combination procedure the "septo" portion being the aspect of the surgery dealing with your functional problems. The "rhinoplasty" portion is the cosmetic aspects that you desire changing. Your insurance company will pay for the functional portion of your surgery however not the cosmetic portion. This will also depend on your insurance provider and this should be pre certified ahead of time for a proper evaluation of what they will cover in your desired procedure. It is important that your surgeon is trained in dealing with both of these aspects of your surgery. A nose needs to be aesthetically pleasing and fully functional. Best regards, Michael V. Elam, M.D.
Web reference: http://michaelelammd.com
Rhinoplasty and Insurance
Insurance usually will cover "functional" nasal surgery. That is, surgery that is required to fix a breathing problem such as a deviated septum, or a nasal fracture among others. Insurance will not cover cosmetic changes.
Broken nose, rhinoplasty and sinus congestion
A broken nose and deviated septum are repaired to improve airflow through the nose and are submitted to medical insurance for medical necessity. This nose may also require a spreader graft on the patient's left side. Any change to the tip of the nose or removing a hump is considered cosmetic and that portion is paid for by the patient. Both procedures can be done at the same time under the same anesthetic. A septo-rhinoplasty will improved the breathing functionality and cosmetic appearance of the nose.
Web reference: http://seattle-rhinoplasty.com
Sinus Blockage, Headache From Injury to Nose. Rhinoplasty and Insurance?
From the photos provided, the nose has a C-shaped deformity from the nasal trauma, which may be the cause of the nasal obstruction. Sinus infections may be related to nasal allergies which is the main reason flonase is prescribed. The nasal allergies have nothing to do with the nasal trauma and unless the septum is severely deviated to the point that it's causing blockage of the sinus drainage areas within the middle meatus (behind the middle turbinate), insurance will not cover that issue as part of a Septo-Rhinoplasty.
Insurance may cover a small part (most likely it won't cover much at all or any) of the Rhinoplasty portion of the surgery. Rhinoplasty would be required to reduce the bony dorsal hump and fracture the nasal bones towards the midline making them less C-shaped. The nasal tip could also be thinned.
Web reference: http://www.drfpalmer.com/Rhinoplasty.html
Correcting nasal fracture
Insurances will typically cover procedures to help improve nasal obstruction. The extent of coverage varies based on the details of the insurance plan. Insurance will not cover procedures that address nasal asymmetry, or bumps, but are not necessary to improve nasal obstruction.
Web reference: http://seattlerhinoplasty.com/html/crooked_nose.php
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.