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Will Insurance Cover Both Septoplasty and Rhinoplasty?

I am an African American woman seeking to get Septoplasty and Rhinoplasty done at the same time. I am worried about insurance coverage.

My mom said that if I were to get the "cosmetic" part of the surgery (rhinoplasty), insurance would NOT cover ANY of the surgery because both procedures were done at the same time & vewied as "Cosmetic Procedure" only. Is this true?

Doctor Answers (11)

Insurance may cover septoplasty

+2

As Dr. Papel has noted, it is quite possible for your insurance to cover the septoplasty portion of the procedure. You should ask your surgeon to clearly deliniate the start and stop time of the septoplasty in their records, as well as showing both the septoplasty and rhinoplasty charges on your bill. I recommend that you have a physician other than your rhinoplasty surgeon document the fact that you have breathing problem attributable to a deviated septum. Then, ask your insurance company for "pre-authorization" to have the septoplasty. In this way, you will have covered all the bases and optimized your chance of having the septoplasty portion of your procedure reimbursed.


Baltimore Plastic Surgeon
3.5 out of 5 stars 3 reviews

Septoplasty and Rhinoplasty Insurance Coverage

+2

Septoplasty gets covered by insurance. Rhinoplasty does not. When you get approval, get approval for only Septoplasty codes 30520.

For the time your surgeon uses to do rhinoplasty part, lets say one hour you will pay the facility (surgery center) a pre negotiated rate anywhere from $500 to $2000 depending on the time it takes your surgeon to do the rhinoplasty part.

Same way with Anesthesiologist's fees. You pay for the time a pre negotiated fee. Most surgery centers have that rate sheet available for doctors.

Remember, when you are getting approval for septoplast you do not have to mention anything about rhinoplasty or it will confuse the insurance people and they might think you are trying to scam them.

Regards

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 25 reviews

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It’s Not Unreasonable To Seek Prior Authorization From Insurance For Rhinoplasty & Septoplasty

+1

                  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 nasal 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. 

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 73 reviews

Insurance covers only what is medically necessary.

+1

Cosmetic and reconstructive surgeries can be performed simultaneously without any problem. The insurance company covers any medically necessary procedures done on the internal portion of the nose such as a septoplasty for breathing. Any elective cosmetic procedures can be done at the same time without any need to worry about insurance coverage issue. The patient is responsible for the cosmetic portion of the nose.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 55 reviews

Insurance Coverage for Septoplasty and Rhinoplasty

+1

Septoplasty may be covered by your health insurance if significant functional issues are caused by the septal deviation. An aesthetic rhinoplasty will not be covered.

In general, it is important for you to be forthcoming with your surgeon and your surgeon to be honest with you and the insurance company about your condition and physical findings. For instance, doing a septoplasty in order to receive insurance coverage in the absence of good medical reasons is certainly not in the patient's best interest ...

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.5 out of 5 stars 24 reviews

Some Rhinoplasty surgeries have both a functional and a cosmetic component.

+1

You can have, and should have your deviated septum repaired at the time of Rhinoplasty surgery. Most Rhinoplasties I perform have both a functional and cosmetic component. And most insurance plans will cover the functional portion of your surgery and the associated anesthesia / facility fee.

Your mom is right. If your doctor tries to get pre-authorization for a Rhinoplasty (not a covered benefit), they may subsequently deny a Septoplasty.

Your experienced, certified Rhinoplasty surgeon would be familliar with the proper protocol for getting the functional portion of your surgery covered.

I hope this helps, and best regards.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
5.0 out of 5 stars 268 reviews

No , this is not true.

+1

 Insurance will cover the functional part (septoplasty or turbinate surgery) but not the cosmetic portion. See an experienced rhinoplasty surgeon and he will tell  you how much of the surgery will be covered when they check with your insurance company.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Insurance Usually Will Cover Functional Portion of Surgery, But Not Cosmetic

+1

Every insurance plan is different, but in general any portion of the surgery that is performed to correct a functional problem -- such a septoplasty to correct a deviated septum -- will be covered by insurance. It is very unlikely that a rhinoplasty would be covered by insurance.

Several important issues that you need to clarify with your surgeon and your insurance company before surgery include:

  • Does your surgeon contract with insurance companies?
  • Is he or she on your insurance plan?
  • Did the doctor's office get the necessary preauthorization or preapproval for the tentatively scheduled surgeries? What will they cover and what will they not cover?
  • Does the surgical quote include anesthesia and OR facility fees?

Addressing these issues before surgery can help alleviate any potential misunderstanding and prevent you from being left with a large or unexpected bill dropped in your lap.

Best of Luck!

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon
5.0 out of 5 stars 85 reviews

Insurance Coverage for Septoplasty and Rhinoplasty

+1

Most insurance companies will not cover truly "cosmetic" surgery. However, if there are significant issues with nasal function that can be documented in a physical exam by a qualified physician it may be possible to combine functional and cosmetic procedures. This must be done carefully and honestly to make sure that second guessing by the insurance company does not negate your legitimate benefits. Speak with your doctor to check on how this works in his/her office.

Ira D. Papel, MD
Baltimore Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

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.