In Jan I would like to do a rhinoplasty procedure for cosmetic reasons but I also need to fix the problems listed above as a functional portion of my nose I have problems breathing through my nose and I have sleep apnea They should pay for the function part of the surgery as well as the operating facility and anesthesia I will shop for a NEW insurance plan in January. How can I know they will pay for this B4 I BUY will giving them CPT codes help? I know they wont pay for the cosmetic part HELP
How to Know for SURE my Insurance Will Pay for a Deviated Septum, Septoplasty, and Turbinate Surgery??
Doctor Answers (7)
You should check with your insurance company to see if you can get pre-authorization for the procedures. I suppose like someone else wrote, prepare to pay for it all jsut in case. But you really should know ahead of time what your insurance company will cover.
Insurance for rhinoplasty
most companies are required to give you preauthorization.. need need the codes, cpt and icd9 and examination as well as a letter of medical necessity.
you purchase your policy and must be your own advocate
The brutal truth is you can never be sure. Even when a physician's office obtains preauthorization for a surgery it alwasy comes written that preauthorization is not a guarantee of payment. Health insurance companies can refuse to pay even if authorized and sometimes employ "recovery companies" to demand money back up to two years after they have paid. This reprehensible practice is only tolerated in the medical field where patients expect third parties to pay for their services and legislatures protect insurance companies.
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Plan for the worst, just in case...
While MOST insurance companies will pre-authorize for common nasal issues affecting breathing and quality of life, there is NEVER a guarantee attached to that. You should have enough reserve finances to account for the possibility of denial, which can happen even with a pre-authorization. However, remember that there is an appeal process with any denial. Good luck!
Insurance for nasal surgery
I agree with the others. You need to read the fine print to be sure there is not a waiting period. Also more insurance plans are requiring a certain period of time, like 3-6 months, of conservative medical treatment before they will approve the surgery. Speak to your benefite office at work for help or contact your insurance representative to also help you.
Insurance predetermination for rhinoplasty
Portions of a rhinoplasty procedure such as repair of a septal deviation may indeed be covered by some insurance plans. In order to know for certain what they will cover involves a predetermination process by the surgeon which will include necessary CPT codes. Confirmation should be in writing, never by phone. Shopping for insurance by telling them what you will need may be self defeating. Preexisting condition exclusions may apply.
Best of luck,
Web reference: http://www.peterejohnsonmd.com/rhinoplasty
Insurance For Rhinoplasty
If you are planning on switching insurance or getting new insurance and then immediately asking them to pay for a known pre-existing condition, your chances of coverage are going to border on 0%. This is like buying car insurance after the accident. If you currently have insurance for a year or more with the same company and your policy includes coverage for your condition, there is a good chance that you will receive coverage for the procedure as defined by your policy. However, even with official "pre-authorization" letters insurance companies have been known to change their minds after the fact. You really never have a 100% guarantee of payment. Furthermore, the insurance company will never pay the OR or anesthesia portions of your procedure that are related to the cosmetic part. Failing to separate out the cosmetic portion of those bills would be fraud.
Web reference: http://www.dr-apo.com/surgical-procedures/rhinoplasty/
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.
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