Twisted/Buckled Tip Resulting In Blocked Airway. Revision Typically Covered By Insurance?

After fracturing my nose, I underwent a Septoplasty which included refracturing my nose and adding spreader grafts in both sides. My breathing became worse, particularly through my left nostril (similar symptoms of a deviated septum). I had the grafts removed, and now understand that my symptoms are a result of a "twisted tip" from the first surgery that severely blocks one nostril. Wondering if it's typical for insurance to cover such a revision, as they covered the first two operations(Cigna).

Doctor Answers (3)

Insurance coverage for nasal obstruction

+1

In general, any functional nasal obstruction is covered by insurance if properly documented. Any cosmetic procedures are not covered. If you address the problem sooner than later, you should be able to ascertain coverage more easily, but the surgeon should be able to precertify your procedure in most cases. This may require pre op photos and office notes as well in some cases. Good luck!


Peoria Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

Functional septorhinoplasty

+1

My experience is that it depends on your timing, your documentation, and your surgeon.  If you are a couple of years after your initial injury, or your revision, your chances for coverage are slim.  If you are within 6 months, your chances are strong.

Documentation of the injury is essential.  An ER visit, a prior docs note, they all help.  So does any documentation from your rhinoplasty surgeon that says the prior procedures did not heal as anticipated, continued NAO (nasal airway obstruction) still exists, or your current obstruction is from your post traumatic nasal anatomy. 

Third is an experience rhinoplasty surgeon that will go to bat for you, that will provide the necessary opinion and documentation to your insurance.  Often the insurance will deny, and an appeal is necessary to get coverage.  There are many docs in Chicago that have that kind of experience, but I have worked with Drs Dayan and Toriumi and they would be excellent options.  But there are many talented surgeons in your area.

Kevin Robertson, MD
Madison Facial Plastic Surgeon
4.5 out of 5 stars 8 reviews

Insurance Coverage for Rhinoplasty

+1

Insurance may help if you truly have a breathing issue, but generally does not cover cosmetic issues. You may want to get the codes from your surgeon and try to confirm directly with your insurer if they will cover.

Roy A. David, MD
San Diego Facial Plastic Surgeon
4.5 out of 5 stars 19 reviews

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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.