Crooked Nose: Covered by Insurance? (photo)

Hi J18;

Your crooked nose looks like it was due to an accident.  If you cannot breathe, then it does, indeed, make sense that you probably have an internally deviated septum, which is probably also the cause of your external crookedness.  Certainly, your nose looks like it.  The sense of smell can also be affected by poor breathing. 

You said that you, "told your doctor…, but she does not think it is serious enough for surgery."  Was the doctor a specialist in nasal surgery?  Or was this your personal doctor?  If the doctor was a family practitioner internist, I think the wise thing to do would be to realize that she may not be an expert, and that you need to consult with a specialist who is.  That specialist would be one who does considerable nasal surgery - both cosmetic and functional - in their practice.  Look for a board certified head and neck (ear, nose, & throat) specialist, or a board certified plastic surgeon specialist. 

With respect to insurance covering your surgery, understand that insurance covers surgery to improve function, such as to improve your breathing or correct allergies and sinus problems.  It does not pay for purely cosmetic changes like reducing the bulbosity of your tip.  Frankly, it pays to combine the procedures because, at least, you will have the benefit of the insurance coverage for a portion of the surgery.

Be sure to have your insurance agent or employer check with your insurer to find out the benefits for the correction of the deviated septum and any other surgery.  The cosmetic rhinoplasty  part will be your treat to yourself. 

Robert Kotler, MD, FACS
Facial Plastic Surgeon
Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON
Author, THE ESSENTIAL COSMETIC SURGERY COMPANION

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.  Insurance may cover the septoplasty, but not the rhinoplasty portion.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!

                  It’s
not unreasonable to seek prior authorization from insurance carriers for both
rhinoplasty and septoplasty simultaneously. Post traumatic deformities of the nose
and deviated septum’s can both be caused by trauma and both problems may
therefore be covered by insurance.

                  It’s
not unusual for septoplasty to be 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.

                  Following
rhinoplasty, patients are eager to resume their normal exercise routine.
Unfortunately, any maneuver that elevates blood pressure in the immediate
post-operative period can result in bleeding. For this reason, strenuous
activities should be avoided for six to eight weeks following rhinoplasty and
septoplasty.