Insurance Coverage for Nose Hump Removal Due to Injury?
- Asked by olympian04 in Ann Arbor
- 3 years ago
I recently broke my nose playing basketball. I had to get it reset back in place by surgery. Since it has healed the bone has seemed to become larger creating a bigger hump on the bridge. I wish I could say it does not bug me but it does. I do not have the money to get a "nose job" and I am not really into plastic surgery (not knocking those who are) is there any way insurance covers this because it was an injury and is there anything I can do to fix it. Thanks.
Insurance covers re-straightening nose from injury
Insurance coverage will only re-straighten the nasal bones from a documented prior injury. It will not address any cosmetic hump removal even though that was due to the injury. This is considered a cosmetic nose job. If the nose is still crooked and displayed then your medical insurance may cover this.
Web reference: http://www.seattlefacial.com
Insurance Coverage for Nasal Hump Removal
Although the hump is secondary to trauma, the insurance company will probably not cover surgery unless there is a breathing or functional problem.
However, when confronted with a similar situation, I will always get the documentation from previous treatment following the accident, do a current examination, and submit this to the insurance company for pre-operative authorization.
Insurance coverage of nasal fracture (nose job) and/or rhinoplasty
Although your insurance may have paid for the intial repair of the nasal fracture it is unlikely that they will cover the subsequent correction unless there is some functional component. This means that your "deformity" must be causing some breathing difficulties. The likelihood of this is relatively low. To know for certain, see a rhinoplasty surgeon and have trhem complete an evaluation and prepare a letter of predetermination of benefits coverage to your insurance carrier.
Recent Rhinoplasty Reviews
Insurance coverage for old injury.
Most insurance companies will only cover this if there is a functional component. You can check with them to get a predetermination of what they will cover.
Insurance coverage for nose hump removal
This is how I handle these situations in my practice. After an in detailed history and physical examination, including 6 photographic views, I request the patient to supply ANY documentation related to the previous injury. This doctumentation is operative reports, office or ER notes and reports, X-ray reports. Anything that will justify the reconstructive portion of the planned operation.
Then we send/call/email/fax ALL this information to the patients' insurance company. Upon a response, in writing, we than review with the patient their 'covered benefits', the out of pocket costs, the non covered costs or cosmetic portion costs. In most circumstances upto 50% is covered by insurance the other is cosmetic costs. So you will have to pay something out of pocket, no free ride. Best of Luck and Regards.
Traumatic hump deformity
Traumatic hump deformities from sports related injuries may in some cases be covered by insurance companies especially if there is a concomitant break or deviation of the septum. I have had many patients be able to have this problem corrected who are basketball players at the local university as well as baseball players. That being said we would have to pre-certify the procedure with your insurance company. One thing you can do is check with your insurance company policy to see if it is a covered procedure.
For a non-cosmetic procedure, often an open reduction of nasal fracture with septal fixation is used so you may try that avenue. In my personal opinion, it should be covered since it is the direct result of trauma as long as you are not seeking to have an aesthetic or cosmetic rhinoplasty done with the rest of your nose at the same time. I hope this information helps.
Unlikely that insurance will cover rhinoplasty
It's unlikely that your insurance company will cover the costs of rhinoplasty, since your predominant complaint is a cosmetic concern, not a functional one. Insurance companies are much more likely to cover some of the costs of rhinoplasty if there is documented airway obstruction or breathing problems. A bump on your nose, although the result of trauma, ultimately is a cosmetic concern.
Hope this helps. Best of luck.
Nasal bump after fracture
Insurance is a contract between you and your insurance company. I suggest you contact your carrier and ask them if a facial fracture is a "covered" expense and get it in writing.
Be aware however, that insurance companies make money by denying claims. So even if in writing, be prepared to fight.
Insurance for a Nasal Fracture
In an ideal world, all defects would be fixed for free. That does not exist. Although you say you are not into Plastic Surgery or a "nose job", I bet your wear nice clothing and try to have a good appearance. That is all that plastic surgery is, we can improve your bump and make your nose look better, if you don't like your appearance. The problem is, you will have to pay for it. Very few insurances pay for nasal bump correction. They may pay for the closed reduction when you hurt yourself but later on, it is up to you.
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.