Ask a doctor

Insurance Coverage for Fixing Broken Nose?

I got hit in the nose, and I'm wondering about how I can get it fixed. I don't want to say i have a deviated septum because I don't. I can breathe perfectly fine. It's crooked and ruins my self-esteem. Is there a way to get this fixed off of my insurance? I should be having medicare/medicaid soon.

Will I need to have a nasty crooked scar, or a scar in general, on the tip of my nose even though it isnt a whole nose fix? This was about a year and 1/2 ago. I know it's been long, but I have parents that don't find it very important as much as I do. What do I do to get it back to the way it was? Thanks.

Doctor Answers (16)

Nsurance coverage for fixing broken nose?

+1
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.  Typically insurance will not cover a broken nose for cosmetic reasons as there is no functional deficit with these fractures.

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!


Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

Insurance paying for broken nose

+1

It is unlikely that an insurance company will pay for the surgery. Usually, insurance companies will ask for the following when someone submits a claim for a broken nose:

1. Emergency room report at the time of injury

2. CT scan which shows broken bones.

3. A report from a qualified doctor saying that the injury is causing some kind of breathing difficulty.

It is unlikely you can have insurance pay unless you have this information.

John Diaz, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 18 reviews

Insurance covers what is medically necessary

+1

Your insurance will not pay for just fixing a broken nose that has been broken a long time ago unless it is causing a breathing problem. There is no medical necessity to fix this other than any cosmetic purposes. This is a cosmetic rhinoplasty, and insurance will not pay for this type of straightening of the nasal bones.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 58 reviews

You might also like...

Insurance coverage for rhinoplasty

+1

Hi,

Thank you for your question.

This is a tough situation. There are several things goin on. It seems as though this is more of a cosmetic procedure which insurance does not cover. Plastic surgery procedures have to be determined medically necessary in order for insurance companies to cover the procedures. Even then, some insurances, especially Medicare/Medicaid, do not cover them fully.

It does not seem like this is medically necessary in your case, especially since it has been over a year and a half and you can breathe just fine. Medicare also does not pre-certify, so they never guarantee procedures, even in the most necessary cases. It would be difficult to find a surgeon who would take the risk of performing the surgery and not receiving payment.

Your story is not completely hopeless, however. Many plastic surgeons offer financing such as Care Credit where you can pay montly payments. Some may even offer payment plans in their office. Depending on what exact procedure you need, this may be an affordable option for you as it would obviously be worth it to you.

Best regards,

Dr. speron

Sam Speron, MD
Chicago Plastic Surgeon

Insurance to pay for nose surgery

+1

Insurance is a contract between you and an insurance company. Your Doctor has nothing to do with the process and will expect to be paid by you. Surgeons fees vary depending on the level of expertise, so you may find variation if you seek more than one consultation.

This is one are in life where it pays to pay retail. Evaluate the surgeon, and their credentials as well as the years of experience.

If you choose to submit the bill for services to a third party, that is your own choice and I suggest you contact whomever that might be with further questions. Insurance companies make money by not paying bills, and the fewer bills they pay, the more money they make.

Despite attempts to regulate insurance companies, they routinely flaunt the law and occasionally will be fined. Relatively small fines are part of their business plan, which maximizes their profit. One example is the misuse of the Ingenix data, try Googleing the words Ingenix and United Healthcare NY attorney general. You will see just one of many examples, where data was intentionally manipulated to lower reimbursement rates.

 

Darrick E. Antell, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 19 reviews

Rhinoplasty for broken nose

+1

Fixing a broken nose is routinely done and is usually covered by the insurance company. However, in order for this to occur, you may need a report from the emergency room that you visited after getting the broken nose along with a CT scan demonstrating the fracture. Otherwise, it may be difficult to convince the insurance company that it's not cosmetic. Good luck!

Jeffrey E. Schreiber, MD, FACS
Baltimore Plastic Surgeon
5.0 out of 5 stars 78 reviews

Insurance coverage for fixing broken nose?

+1

Hello,

Your situation is not unique and you have a LOT of good answers to your question from other doctors. They parallel my opinions. If you have pictures of how you looked before the injury this can help your case.

As I see it, your real outlet is to go to a teaching Hospital as recommended by the other responders unless you are going to pay for the procedure.

Michael Kulick, MD
San Francisco Plastic Surgeon
2.5 out of 5 stars 3 reviews

Need a physical examinaiton

+1

You will require a physical examination to determine the extent of your nasal injury.  At this time a plastic surgeon can determine if this is a reconstructive procedure or cosmetic procedure. 

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 10 reviews

Rhinoplasty insurance coverage

+1

The insurance company may only pay to re-align your bones. If you desire cosmetic improvement of your nose, then you will have to pay out-of-pocket.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Sounds like it is cosmetic at this time

+1

Insurance will usually pay for an acutely fractured nose to be repaired. This really means that they will pay to have the bones placed back to the original configuration. They will not pay for cosmetic rhinoplasty.

Deviated septum form my point of view is a misnomer. Nobbody has a perfectly straight septum. The deviated part is only important if it compromises nose function, from the insurance point of view.

sek

Scott E. Kasden, MD
Dallas Plastic Surgeon
4.5 out of 5 stars 51 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.