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Insurance Cover Rhinoplasty or Nose Job Surgery?

I am interested in having a rhinoplasty or nose job. What cosmetically bothers me is the hump or bump I have on my nose that makes it look crooked. I also have trouble breathing and an ent i saw years back said I have a deviated septum. Would insurance cover any of the bump correction if I have surgery to correct the deviated septum? And if not, how much will be left for me to pay if I choose to do the deviated septum and rhinoplasty at the same time? I'm assuming i wouldn't have to pay for anesthesia so how much would the total doctor fee only be approx? How much was your surgery?

Doctor Answers (4)

Insurance Coverage For Rhinoplasty and Septoplasty

+1

As pointed out by other surgeons, the answer to this question can get very complicated.

Your health insurance plan should cover any nose surgery (including surgeon fees, anesthesia and facility costs) that is done with the specific intention of improving your nasal breathing and/or repairing structural damage from a nose injury. Of course, obtaining pre-authorization from your insurance carrier is always recommended. This means the proposed surgical procedure and indications for the surgery are presented to your insurance carrier in advance. They review the documentation provided and respond accordingly whether or not they feel the surgery is medical indicated. If the answer is yes, they will usually provide coverage (payment) for those procedures requested.

Anything done during that surgery that is intended to reshape the nose for cosmetic reasons is not covered. This includes any supplies used and anesthesia given during that time devoted to the cosmetic portion of the surgery. Consequently, you will be responsible for paying out of pocket for the surgeon fees, anesthesia and facility costs for this portion of the case. Although you are already asleep under anesthesia for the functional surgery, the anesthesiologist is required to bill you separately for the time spent under anesthesia for the cosmetic reshaping.

Usually the total cosmetic fees (surgeon, anesthesia and facility combined) are discounted when done in combination with insurance procedures. However, you as the patient need to be mindful that you are still responsible for any and all deductibles and copays triggered by your health plan. Some patients have a low deductible while others have a high deductible. This can significantly impact how much you end up paying in total for both the functional surgery and the cosmetic reshaping. Make sure to read your individual policy very carefully and ensure that you understand the terms of your policy in detail. This can be the source of much disappointment in some cases.

Web reference: http://www.drhilinski.com/procedures/rhinoplasty-san-diego-ca/

San Diego Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

Insurance payment for septoplasty or nose surgery

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How much insurance will pay for nasal surgery is a very gray area. This is especially true when there is a functional component.

A septoplasty does not change the shape of the nose and is therefore considered a functional procedure as opposed to a cosmetic procedure. As such, it is a procedure that insurance should pay for (as well as facility fees and anesthesia costs). Verification of benefits and prior authorization before surgery should be obtained.

Rhinoplasty is considered a cosmetic procedure. It is very unlikely that insurance will contribute to that portion of the procedure. Even though the rhinoplasty portion of your surgery will be considered cosmetic, the functional component will be covered by your insurance and may decrease your out of pocket expense.

However, for patients with a history of prior nasal trauma and documented symptoms of nasal obstruction, a septorhinoplasty may be covered by your insurance. This terminology denotes that the surgery is performed to correct funcational problems and required reshaping the nose.

Choose a rhinoplasty surgeon who has experience in correcting both functional and cosmetic nose problems. Check to see if the physician's office can assist with your arranging your insurance pre-authorization.

Web reference: http://rhinoplasty-usa.com/html/meet-dr-cochran.html

Dallas Facial Plastic Surgeon
5.0 out of 5 stars 81 reviews

Insurance Coverage for Rhinoplasty

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The insurance coverage for surgery is dependent on your individual healthy insurance policy. For nose surgery, most insurance companies will scrutinize the procedure carefully to make sure that it is not for cosmetic reasons. Insurance may cover nose surgery for breathing problems like a deviated septum. If you decide to add a cosmetic refinement of the nose to the insurance coverage nose surgery, then you will have to incur the cost of the cosmetic portion. That includes that surgeon's fee, anesthesia, an operating facility. Each facility, anesthesia, and surgeon will have their own fee schedule.

Orange County Plastic Surgeon
5.0 out of 5 stars 3 reviews

Insurance coverage for rhinoplasty

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Most insurance companies will pay for the functional portion of your sugery. It is always a good idea to get a predetermination of benefits before embarking on an elective surgery such as a septoplasty. The bump on the nose would be considered cosmetic and insurance will not generally pay for that portion of the procedure. The costs involve will vary depending on your insurance, the location of the procedure, and the area of the country you are in. Generally you will have a facility fee, a surgeon's fee, and an anesthesiologists fee. All of these will vary. Remember though, rhinoplasty is one of the most difficult cosmetic surgeries to get just right. Visit with a qualified and experienced facial plastic or general plastic surgeon and not just the least expensive guy in town.

Dallas Facial Plastic Surgeon
4.0 out of 5 stars 10 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.