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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 (13)

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
3.0 out of 5 stars 4 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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Septoplasty and Rhinoplasty - Insurance coverage ?

+1
A rhinoplasty (cosmetic) can be done without a septoplasty - the operations are unique and exclusive - we typically bill insurance for the septoplasty and patient pays out of pocket for rhinoplasty. This system works fine and we have not had any issues.

Scott C. Sattler, MD, FACS
Seattle Plastic Surgeon
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Will insurance cover both septoplasty and rhinoplasty?

+1
Hello! Thank you for your question! Surgical procedures for aesthetic purposes, to improve appearance, are not covered by insurance. Typically, these as well as complications resulting from such procedures are the responsibility of the patient. Procedures that are meant to correct functional issues and those which cause health-related issues should be covered by your insurance as a medical necessity, with proper examination and documentation. Some insurance plans have exclusion criteria for certain procedures. Also, it is an obligation of the surgeon not to attempt to authorize purely cosmetic procedures through insurance.  The septoplasty portion is typically covered, however not the rhinoplasty.  The facility and anesthesia times should commence once the septoplasy ends.

Discuss your issues and complaints with a board-certified plastic surgeon to discuss these as well as to examine and assist you in deciding which procedure(s) will be the best for you. A discussion of the advantages and disadvantages will take place along with the risks and benefits. Insurance companies will vary on coverage and is always reasonable to discuss your issues with your surgeon and primary care. It would behoove you to get as much information as possible and even call your insurance yourself. Certainly, pay in advance prior to your surgical procedure and options such as financing are available if you qualify. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

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 78 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 58 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 27 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 278 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 15 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.