If the situation comes up as a fraud issue then ill have to have the surgeries seperated which is ridiculous. Any ideas? I already I have a preapproval for the septoplasty.
I Have a Diagnosed Turbinate and Septum Issue and I Want a Rhinoplasty. Will I Get Fees Waived?
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Functional septoplasty and cosmetic rhinoplasty billing
A patient can choose to pay for the functional septoplasty and the cosmetic rhinoplasty bot out of pocket in cases where they dont have insurance or if they have bad insurance with poor coverage and high deductables.
If they have insurance, the functional portion (septoplasty and turbinate reductions) can be billed to insurance. When I operate, the nursing staff and anesthesiologists know exactly the amount of time I spend on the insurance portion (septum) vs the cosmetic portion and I keep those separate and even dictate separate Operative Notes. That way there is no mixing of billing and there is no fraud and the two are totally separate but performed during the same anesthesia period. So for example 1 hour would be dedicated to the cosmetic and 30 minutes to the functional portion because we never want to bill insurance for any cosmetic procedures despite the fact some patients ask us to and some doctors do but that would be fraud.
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Insurance for Septorhinoplasty
Most insurance plans will pay for the septal and turbinate correction to improve nasal function. You will have to pay for any cosmetic changes. There will be no fraud issue.
Combining medically necessary and cosmetic procedures
The turbinate and septum surgery lasts approximately a half an hour and the rhinoplasty lasts approximately an hour. The septoplasty and turbinate reduction are done out of medical necessity and are billed to the patient’s medical insurance for the time allotted to perform those specific procedures. This includes fees for the surgeon, operating room, and anesthesia. The rhinoplasty component of the procedure (operating room, surgeon’s fee, and anesthesia) is NOT billed to medical insurance, but paid for by the patient. Both functional and cosmetic surgery can certainly be performed at the same time under one general anesthesia, but the billing has to be separated.
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Combining Functional and Cosmetic Nasal Surgery
Thank you for your question about a topic that arises frequently. Functional nasal surgery (septoplasty, turbinate surgery) related to nasal breathing can be covered by medical insurance. That does not change the shape, size or external appearance of the nose. Check with your insurance carrier about any out of pocket expenses in the form of deductible and co-payments for which you may be responsible. Cosmetic changes to the appearance of the nose may be addressed with Rhinoplasty, which is not covered by medical insurance. Both procedures may be undertaken at the same time, which may be advantageous for several reasons. The cosmetic portion of the surgery will incur out of pocket charges.
Rhino septoplasty and turbs
It is not at all unusual to have these procedures combined. Don't worry about the issue of fraud as long as you are honest about the insurance paying for the functional part and you paying for the cosmetic part. Just don't expect the insurance to cover all or even most of the cost. I am sure your plastic surgeon is used to dealing with this situation. You will likely be required to pay for at least the cosmetic portion before surgery.
Simultaneous airway and cosmetic nasal surgery-fraud or not?
This is not an unusual situation. The insurance company will only be asked to cover the functional(airway) part of the procedure so the issue of fraud is not relevant.
Rhinoplasty - cosmetic vs functional
Many rhinoplasties involve both functional improvements and cosmetic improvements. These are usually done at the same time; you would never want to have them done separately!
Most plastic surgeons who perform aesthetic improvements on the nose are very familiar with the 'inner workings' of the nose as well!
Insurance For Rhinoplasty #nosejob
I do these cases all the time. If you have a functional issue and you have been approved and you also want cosmetic surgery as well you can do both at the same time without any fraud issues. It is very simple. The anesthesia team and nurses in the operating room will keep a non-cosmetic time clock and a cosmetic time clock. The appropriate portion will be billed to insurance and the other portion you are responsible for.
Richard J. Brown, M.D., F.A.C.S.
If you ahve an airway issue and the insurance company will cover it, that will apply to that portion of the procedure. Any cosmetic work will have to be paid out of pocket.
Rhinoplasty: Functional & Cosmetic
The functional portion (e.g. septoplasty and turbinate reduction) will be charged separately and can be covered under insurance minus the deductible and copays. The cosmetic portion will need to be paid out of pocket. Some insurance companies can take a long time to pre-approve the functional portion. Please consult with a board certified specialist who can assist you in achieving the results you seek.
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.