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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?

Doctor Answers (4)

Rhinoplasty is not a covered benefit by most insurance companies

+2

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 nasal deformities, and nasal deformities as a result of a motor-vehicle-accident.

I hope this was helpful, and very best regards.


West Orange Facial Plastic Surgeon
5.0 out of 5 stars 287 reviews

Rhinoplasty is considered cosmetic

+1

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.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

Insurance does not cover cosmetic surgery

+1

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.

Phillip Langsdon, MD
Germantown Facial Plastic Surgeon
5.0 out of 5 stars 2 reviews

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Insurance Coverage for Rhinoplasty

+1

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!

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.5 out of 5 stars 28 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.