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Insurance Coverage for Deviated Septum and Nose Hump Caused By Broken Nose

I broke my nose 5 years ago but did not have it fixed. I am having trouble breathing through my nose especially on one side, and have regular headaches. Prior to this I ran on a regular basis, but one nostril closes on me now making it impossible to breathe correctly while running. The break in my nose has also caused my nose to be slightly crooked at the top but more significantly created a large hump. I have documentation of the break from the ER. Will all of this be covered by the insurance?

Doctor Answers (11)

Insurance coverage for nasal surgery

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A deviated septum and nasal fracture is generally covered under medical insurance. Collapsing of a nasal valve may require a spreader graft and is often covered by medical insurance. This will have to be documented on physical examination by the surgeon and then submitted for preauthorization prior to undergoing this type of functional reconstructive surgery. Any cosmetic changes to the nose are considered cosmetic and will have to be paid for by the patient. In addition to insurance coverage, co-pays and deductibles will apply to the patient as well.  


Seattle Facial Plastic Surgeon
5.0 out of 5 stars 55 reviews

Nasal surgery and insurance coverage

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It is tough to say whether or not the insurance company will cover it. You have to check what their criteria are.  It may.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Dorsal Hump after Nasal Fracture

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This is a question that I often encounter with my patients.

While insurance should cover your septoplasty and, potentially re-breaking your bones in order to straighten then for functional purposes, profile reduction is not typically covered.

Insurance only covers those changes that are having a functional impact on your nose. Unfortunately, the dorsal hump is not a functional issue but, rather, a cosmetic issue. Insurance does NOT care that it happened as a result of a trauma.

Facial scars are another example just like the dorsal hump. Commercial Insurance will not cover a scar revision unless it causes a secondary functional issue, like an inability to open your eye fully or open your mouth fully.

Hopefully you can find a middle ground between coverage and cost that allows you to move forward with the corrective procedure you desire.

Best of Luck 

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

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Insurance Coverage for Repair of Nasal Fracture

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You are fortunate to have documents that will clarify your injury and treatment. It is impossible for any of us to answer your question - it will depend on the details of your policy, but it is very unlikely that all medical costs will be covered. The staff in your surgeon's office will help you deal with the insurance company.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Will Insurance Pay for Fixing MY Septal Deviation with Obstructed Aiway?

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Regarding: "Insurance Coverage for Deviated Septum and Nose Hump Caused By Broken Nose
I broke my nose 5 years ago but did not have it fixed. I am having trouble breathing through my nose especially on one side, and have regular headaches. Prior to this I ran on a regular basis, but one nostril closes on me now making it impossible to breathe correctly while running. The break in my nose has also caused my nose to be slightly crooked at the top but more significantly created a large hump. I have documentation of the break from the ER. Will all of this be covered by the insurance
?"

From your description it is clear that you have a septal deviation with airway obstruction related to your nose injury. As such, it is reasonable to expect your insurance to pay the costs of having this repaired. However, what is logical and what is reality may not always overlap.

Each insurance company has an individual contract with each one of us which summarizes our duties and obligations. Your contact MAY exclude prior conditions or may exclude this type of coverage/ Not likely but possible.

Review your contract, then go see a plastic surgeon and have him examine you. If he verifies the suspected finding, your surgeon will have to get a permission from the insurance company to perform the operation. Submitting the ER documentation along with his request to perform the operation will increase the chance of approval.

Dr. Peter Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 60 reviews

Insurance USUALLY covers nose surgery after trauma

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Based on your description, most insurance companies will cover the costs of all, or at least part of, your surgery.

That being said, never take anything for granted when it comes to insurance coverage for elective surgery. You need a predetermination or pre-authorization letter from your insurance carrier before surgery because some policies have exclusions or require special tests before approving payment.

You don't want to get stuck with an unexpected bill!

Lawrence Iteld, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 20 reviews

Insurance Coverage for Deviated Septum and Nose Hump Caused By Broken Nose

+1

From your description and documentation your health insurance should cover the operation of a Septo Rhinoplasty. But it is up to you to obtain prior authorization with the help of the boarded plastic surgeon you have chosen. Best from MIAMI Dr. Darryl j. Blinski

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 61 reviews

Yes, insurance will likely pay for your rhinoplasty

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Hi Macias,

For problems related to breathing, insurance will almost always pay for the procedures.  This is because the procedure is being done for reasons related to the inability to breathe.  You need to schedule an appointment with a surgeon in your area who can evaluate you, take photographs, and request insurance approval.  For all of my patients, I have them try a course of nasal saline sprays or irrigations and, usually, nasal steroid sprays, to see if this will improve the symptoms.  If breathing through the nose is still difficulty despite use of nasal sprays, then surgery is the best option.  Of course, if the procedure is being done for cosmetic reasons, insurance will not pay.  

I hope that helps!

P. Daniel Ward, MD
Salt Lake City Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

Insurance will cover part of the surgery

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Rhinoplasty for a deviated septum will usually be covered only for the reconstructive portion, those to improve your breathing.  As far as changing the shape of the nose that would not be covered and probably be an out of pocket expense to you.  Again make sure your plastic surgeon and you get pre-authorization for your surgery.  Good Luck, Dr Schuster in Boca Raton

Steven Schuster, MD
Boca Raton Plastic Surgeon
4.5 out of 5 stars 3 reviews

Insurance coverage for septo-rhinoplasty

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If you are having trouble with breathing along with a deviated nasal septum; insurance will generally cover this.  When the septum is corrected, the crookedness of the nose will also be corrected.  Work with your plastic surgeon and make sure to get preauthorization from the insurance company.

Best Wishes

Dr. Peterson

Marcus L. Peterson, MD
Saint George Plastic Surgeon
4.5 out of 5 stars 13 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.