I sometimes have difficulty breathing but it is not life threatening at all. I am looking to have my doctor refer me to a plastic surgeon to do a Rhinoplasty. I currently have the best insurance Cigna has to offer, and was wondering if my current symptoms would be good enough to qualify for insurance coverage.
Insurance Coverage for Rhinoplasty for Breathing Problems?
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Insurance covers what is medically necessary, not cosmetic
A rhinoplasty is not performed for breathing problems out of the nose. This is called a septoplasty. Sometimes turbinates can be trimmed and adjusted at the same time to improve airflow dynamics through the nose. A rhinoplasty is performed for cosmetic purposes and is not billed to an insurance company. Any cosmetic change in shape to the nose is paid for by the patient. Any medically related breathing problems could be covered by medical insurance.
Best Cigna insurance for Nose Surgery
Dear Gone in Oregon,
Medical insurance AND the Governmental agencies which are supposed to watch over them are not much above criminal enterprises.
We have a government where the Medicare code has more pages than our Tax code - both of which very few people have read much less understand. We have thousands of insurance companies which must conform to 50 different sets of State laws - but the state's insurance commissioners often choose NOT to regulate them.
Each of these thousands of insurance companies then sells tens to hundreds of DIFFERENT policies. Each such policy covers certain procedures and care but does not cover others. To complicate matters further, insurance companies do not pay doctors the same amount for the same treatment and doctors, by law, are not allowed to discuss such payment with each other. As results, some doctors may accept SOME but not all of a certain insurance company's products and definitely do not work with all the insurance companies selling their products in a certain area.
The ONLY way to find out if YOUR CIGNA policy even pays for nose surgery is to look through your insurance book. The fact that you have to go through your ?family practice doctor suggests you MAY have an HMO which by design seeks to limit and restrict referrals to and use of specialists, including Plastic surgeons. Although HMO's sometimes make you feel that way, a medical condition NEED NOT BE "life threatening" to be treated.
I would suggest you closely read you book and find out if such procedures are even paid for.
As regards your nose, the facts that you only "sometimes have difficulty breathing " suggest that you may have an allergic component. I would see a good allergist first to make sure you do not have an easy to fix cause BEFORE seeing a nose surgeon.
I hope this was helpful.
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Rhinoplasty; Insurance Coverage for Breathing Problems
Insurance companies will pay for functional nasal breathing correction (septoplasty) if it is documented that a patient has breathing difficulty. The septal surgery has to be pre-authorized. This usually includes operating room and anesthesiology fees.
Insurance companies will not pay for rhinoplasty (cosmetic changes to the nose). You will likely need to pay a separate fee if you have rhinoplasty with your functional correction. You may be able to find "creative" plastic surgeons, but some have gone to prison for getting too creative with fraudulent billing practices.
Chose you rhinoplasty surgeon carefully.
Insurance Coverage for Rhinoplasty
Insurance will cover for rhinoplasty if an examination documents that your nasal breathing is impaired and despite the use of nasal sprays and medications like anti histamines there is no relief.
Typically the breathing related issues are different then the appearance of the nose. The nasal obstruction is usually either from the septum or narrow nasal valve. Correcting the septum will have no bearing on the appearance. Correcting the nasal valve will change the middle of the nose and might make it wider.
Rhinoplasty for improving the appearance of the nose is completely separate issue and insurance will not cover it.
Insurance coverage for breathing problems
It would be best to have an evaluation by someone versed in both functional and esthetic nose problems. In most cases, your symptoms should be treated with prescription medication before you consider surgery for a functional breathing problem. This may be all you need to breath better. If your symptoms are not significantly better, you may benefit from undergoing some type of functional nasal surgery. This includes procedures like septoplasty, spreader graft placement, batten graft placement, and inferior turbinate reduction or submucous resection. In still other cases, you may need to have your sinuses evaluated as well. There is usually very specific documentation and language required to be submitted by your surgeon to the insurance company.
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.