How to Get Insurance to Cover Rhinoplasty?

I broke my nose when I was younger and had to have surgery. I had problems breathing out of my right side. I had a Septoplasty by an ENT doctor about 2 years ago and now I have dried up blood blocking my breathing and lost my breathing from the left side.

I went to a plastic surgeon who seems to have the knowledge to fix my issue with a Rhinoplasty, but the insurance denied my pre determination. What's my best argument in the appeals to get this approved?

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4 Doctor Answers | Asked by msurg in Green Bay, WI

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Rhinoplasty is not a covered benefit by most insurance companies

Dear Msurg, It seems like you have two issues going on. One is a breathing / bleeding issue after septoplasty. And the other is dissatisfaction with the appearance of your nose. The best specialist to advise treatment for you would be a double-board-certified ENT and Facial Plastic Surgeon. A good way to find one is through RealSelf.com or through the ABFPRS (Am. Board Facial Plastic Reconstructive Surgery) web site. The only Rhinoplasty procedures I've done through insurance are cleft-lip... more

Eric M. Joseph, MD

197 reviews

West Orange Facial Plastic Surgeon

www.ericmjoseph.com

Rhinoplasty is considered cosmetic

A rhinoplasty is never paid for under medical insurance since it is cosmetic. Medical insurance will usually cover a broken nose that is causing a breathing problem or any type of other-related breathing problems. Check with your insurance booklet for preexisting conditions, co pays, deductibles, and exclusions for cosmetic surgery.

Insurance does not cover cosmetic surgery

Insurance usually only covers Septoplasty if preformed for functional reasons; to improve breathing. It usually does not cover a cosmetic alteration of the external nose. A broken nose is not a justification for insurance coverage for cosmetic alteration of the bridge or tip.

Insurance Coverage for Rhinoplasty

Insurance plans differ in their coverage guidlines for nasal surgery. In general, only functional issues (i.e., breathing problems) MAY be considered if they can be corrected with reconstructive nasal surgery. In seeking insurance coverage it is important to be honest with your rhinoplasty surgeon and the insurance company!