Will Insurance Cover Both Septoplasty and Rhinoplasty?
- Asked by Hollywood Princess in Charlotte, NC
- 4 years ago
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?
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Insurance coverage for anything related to plastics is very iffy these days.
Most insurances will cover the functional portion or the septoplasty. Most doctors dictate 2 separate OP reports,one for the cosmetic portion and one for the functional portion. that is usually the way its done and it should not be a problem but you need to check with your own doctor and insurance company.
For the anesthesia and hospital fees, the portio of the surgery involved with the septoplasty gets sent to insurance and the cosmetic portion, again you would be responsible for.
Now there are lots of doctors doing this in different ways. The most important thing is to do it the right way and the honest way as to not be mistaken for something that its not - insurance fraud. Having your insurance pay for the septoplasty portion of a rhinoplasty is completely Kosher and not insurance fraud.
Insurance may cover septoplasty
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.
Septoplasty and Rhinoplasty Insurance Coverage
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.
Web reference: http://www.janjuafacialsurgery.com
Recent Rhinoplasty Reviews
Insurance covers only what is medically necessary.
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.
Web reference: http://www.seattlefacial.com
Insurance Coverage for Septoplasty and Rhinoplasty
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 ...
Some Rhinoplasty surgeries have both a functional and a cosmetic component.
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.
No , this is not true.
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.
Insurance Usually Will Cover Functional Portion of Surgery, But Not Cosmetic
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!
Web reference: http://www.rhinoplasty-usa.com/html/meet-dr-cochran.html
Insurance Coverage for Septoplasty and Rhinoplasty
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.
Will Insurance Pay for Both Rhinoplasty and Septoplasty?
Dear Hollywood Princess,
Not only will insurance not pay for rhinoplasty, President Obama plans to tax you 10% right up the nose for any cosmetic procedure in the future.
As for insurance paying for septoplasty, they will throw a few dollars to the doctor, charge the patient a co-payment on top of the inflated premiums and deductibles that they have to pay, and laugh all the way to the bank with their corporate profits.
No wonder that so many physicians no longer have contracts with health insurance companies.
Best for the Hollywood Princess to find a Hollywood Prince or King to pay for her Hollywood nose job. Also best to keep the cosmetic and functional (septoplasty) portions of your surgery quite separate.
Good luck and be well, do choose your rhinoplasty surgeon carefully.
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.