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Will Insurance Pay for my Rhinoplasty to Address Breathing Problems?

i broke my nose 4 yrs ago recently i have had problems breathing. the r.side of my nose has a bump on the side,also have a fairly large bump on the bridge.my mom got hers fixed in '82 and insurance paid for most of it because it was a deviated septum her doctor also corrected her nose for no extra cost. if a doctor believes i have a deviated septum will they cover the procedure?how do i go about getting something like this?would fixing the dev.sep. make my nose look different?anything else?

Doctor Answers (12)

Insurance Dollars for Rhinoseptoplasty

+1

It has been my experience that it behooves the surgeon to obtain pre-authorization for their surgery.   The third party will usually pay for medically necessary surgery, provided apporpriate medical documentation to support the proposed surgery is available.   If there is associated trauma to the nose, the third party will often pay for reduction of a nasal fracture more readily than pay for a rhinoplasty.   Third parties typically deem rhinoplasty a cosmetic surgery.  They regard septoplasty and turbinectomy as medically appropriate surgeries performed for medical necessity.

Since septoplasty and turbinectomy are performed to improve breathing, third parties tend to pay for these procedures.   If one is to perform rhinoplasty at the same time, the third party will deny payment for the cosmetic portion of the surgery----rhinoplasty.

 


Palm Beach Plastic Surgeon
5.0 out of 5 stars 5 reviews

Insurance for Septorhinoplasty

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You have both  functional and cosmetic concerns. Depending on your policy, insurance frequently pays a portion of the charges to improve your breathing. It would help if you can document your previous nasal trauma because the insurance company may treat this as reduction of nasal fractures. Your surgeon's office can request pre-operative authorization to help you determine your personal responsibility

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

Will insurance cover rhinoplasty?

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Question: Will insurance pay for my rhinoplasty to address breathing problems?


Answer: If you truly have breathing problems caused by an anatomical obstruction of your airway and, if this can be proven to the insurance company, and, if the insurance company accepts the story, the insurance company may honor and may pay for a portion of the procedure. Basically, insurance companies are very skeptical. They understand that the majority of people desiring a rhinoplasty do so for cosmetic purposes. Today, it is very difficult to convince an insurance company that the rhinoplasty is being performed for functional and not cosmetic purposes. If the insurance company does agree to pay, they will most likely pay very little with the vast majority of the procedure to be paid directly by the patient. In all fairness, looking at the picture of your profile, it appears that you are desiring a cosmetic rhinoplasty, even if there is a functional component. Having said this, looking at your picture, I feel that, you have the potential of looking beautiful with a well performed rhinoplasty as well as the addition of a chin augmenting mentoplasty to give better balance to your profile.

Sigmund L. Sattenspiel, MD
Freehold Facial Plastic Surgeon

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Insurance companies vary in their coverage for functional rhinoplasty

+1

The best place to start in obtaining information about insurance coverage for rhinoplasty is to call your insurance company or do an internet search for their policy.  The next step would be to visit an experienced rhinoplasty surgeon for an evaluation for both your functional as well as cosmetic nasal issues.  A precertification is often necessary.  Insurance companies do not typically cover cosmetic nasal issues, and the surgeon may charge an additional fee for their correction. There is often an additional facility fee for the time it takes to perform the cosmetic portion.  Some patients even choose to pay out of pocket for everything depending on their deductable.

Kevin Ende, MD
Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 1 review

Certain Portions of Rhinoplasty Surgery May be Covered by Insurance

+1

Rhinoplasty is not one operation, but rather many potential operations to improve the nose and nasal breathing. Rhinoplasty surgery to improve a congenital deformity, acquired nasal injury, or sinus problems may be covered by your insurance provider, as these are considered more reconstructive plastic surgery. Rhinoplasty to improve a hump or narrow nasal tip is less likely to be covered by insurance, as it is considered cosmetic surgery. Lastly, insurance providers and plans are specific for each individual, so check with your carrier. Speak with a rhinoplasty surgeon to help determine appropriate options for you.

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 46 reviews

Insurance will cover a broken nose or an airway problem.

+1

How much they will pay will depend on the insurance company. Good insurance pays better than poor insurance. You can call and ask how much they will cover.

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

Insurance payment of FUNCTIONAL Nose Surgery

+1

Most Americans THINK that medical insurance pays/should pay for every medical diagnosis or treatment. That is NOT the case. Your PARTICULAR policy clearly spell out what specific diseases/disorders they will pay for and how much YOUR share of the payment will be.

Rhinoplasty can be functional (to improve breathing) or Cosmetic (to improve appearance). While MOST (not all) insurance policies MAY pay for functional rhinoplasties, none will pay for cosmetic rhinoplasties.

You need to start by checking YOUR benefit book and see if nose surgery for improved breathing is "covered". If it is not, you can call their help number but your chances of convincing them to pay for something you did not pay premiums on is slim to zero. If your policy does have such benefits, find out WHO its "providers" are - the doctors willing to accept the payments your insurer dolls out. With that list, Google them and see 2-3 of them and see who you like best.

from the single profile you submitted, you MAY want to consider a Cosmetic rhinoplasty as well (payable out of pocket) to reduce the back of the nose, reduce the anterior nasal spine to smooth the protrusion at the base of the nose and placement of a chin implant to improve facial height and symmetry.

Good Luck.

Dr. Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 58 reviews

Insurance coverage for rhinoplasty

+1

Most insurance companies will cover the functional portion of a rhinoplasty. They typically will not cover any cosmetic surgery. It really depends on what your surgeon is willing to accept in payment for his services.

Robert M. Jensen, MD
Medford Plastic Surgeon
4.5 out of 5 stars 20 reviews

Insurance for nose job

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Depending on your carrier and plan, insurance should cover the functional portion of your nasal surgery such as correcting a deviated septum, nasal valve collaps, or reducing the size of the turbinates. Changes to the outside of the nose are typically not covered by insurance.

Etai Funk, MD
Houston Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

Yes, to help you breathe, but probably not to remove the hump

+1

It is getting harder and harder to predict whether or not insurance will cover certain procedures. However, usually for breathing problems like a deviated septum or collapsed nasal valve, insurance will cover the surgery.  If you feel your nose has changed in appearance after the trauma 4 years ago, insurance may or may not cover that part of the surgery. It will help you plead your case if you have X-rays, doctor visits, ER visits, or any paper trail about your prior fracture. Might be most helpful to contact your insurance company and see what they say. Best of luck to you.

Theda C. Kontis, MD
Baltimore Facial Plastic Surgeon
5.0 out of 5 stars 7 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.