Insurance Coverage for Rhinoplasty for Breathing Problems?

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.

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... more

Hi Gone, 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"... more

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... more

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... more