Saturday while playing basketball a girls head collided with my nose and broke it. It is curved and my septum is deviated. I did go to the emergency room and they took xrays. Yesterday I went to the ear, nose, and throat doctor. He said insurance may not cover getting it fixed. Why would that be so?
Will Insurance Cover Rhinoplasty After Accident?
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Crooked nose and insurance coverage
If your nose is crooked or you have difficulty breathing, then there is a good chance that your insurance company would cover the costs of your surgery. We are also offering a temporary economy price reduction on all cosmetic surgery. Watch the video.
Insurance covers what is medically necessary
Insurance will never cover a rhinoplasty. An accidental fracture of the nose is submitted to medical insurance. Most of the time when the nose is broken a deviated septum occurs at the same time. X-rays will document the fracture, but it is not always conclusive. As long as you have an injury report, accompanying x-rays, and physical examination from your doctor, the medical insurance should pay for the procedure. Any surgery on the nose for cosmetic purposes is not covered by a medical insurance plan. Simple straightening and realigning the bones from a break should be covered.
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Insurance Payment for Repair of Broken Nose
If there is a change in appearance or function, insurance companies will usually pay to restore a nose to it's pre-trauma status. Your surgeon caqn request pre-operative authorization and ask how much your company will pay for the surgery.
Nose job and/or nasal fracture coverage by insurance companay (= functional rhinoplasty)
Increasingly insurance companies will cover functional and NOT reconstructive surgery. IF the insurance company labels your repair as non-functional, this designation may indicate that it is not eligible for coverage benefits.
If the X'rays demonstrate a nasal fracture you should be covered
If the X'rays taken in the E.R. demonstrate a new nasal fracture then I too would expect the Insurance to cover some if not all the costs depending on your specific policy. As well, the existence of a deviated septum in conjunction with a new or long standing history of breathing difficulty should gain you some coverage.
Insurance Coverage for Broken Nose Surgery after Injury
Benefits vary for each insurance provider and plan participant. Generally, acute trauma or injuries are covered by insurance plans, such as restoring a broken nose via a closed or open reduction soon after the injury. However, rhinoplasty to change the appearance of the nose long after the initial injury may not be covered. Speak with your insurance provider and nasal specialist to determine appropriate options. Best of luck.
Insurance will cover a broken nose.
But when it comes to how much they will cover, that is different for each insurance company. You can have your surgeon get an estimated dollar coverage from the ins. company.
Yes and no
Insurance usually covers a "closed reduction" - this is where the curve or deviation of the nose is corrected. It does not narrow the nose or get rid of a bump - it is purely to put the nose back to where it was before the injury.
If you want a cosmetic rhinoplasty it is not covered by insurance.
The Vast Majority of Insurance plans DO pay for Nose Repair
Sounds like you need a closed reduction of your nasal fracture. I cannot speak for YOUR policy or the ENT's experience with plans in Alabama but in western Tennessee we have had no problems having insurance companies pay for restoring an injured nose back to its former condition. This is NOT Cosmetic Surgery. This is Reconstructive surgery.
Since there is a time window on when the bones can be shifted back to their rightful positions, you may want to call your Insurance Customer Service and even the Insurance Commissioner in your state to set matters clear. You may also check with ANOTHER plastic surgeon. He may feel differently about it.
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.