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How To Find An Insurance Company That Will Cover My Rhinoplasty For Injury Related Reasons? (photo)

A few months ago I broke my nose playing basketball. Since that time I have had trouble breathing through my nose. There is no doubt that I have a deviated septum and crooked nose. It looks like it is going to cost around $10,000 to get this fixed. How can I find insurance that will cover part of this and would this case be considered pre existing? I don't have a problem covering part of this or at least the cosmetic portion. From the pictures what kind of surgery does it look like I need?

Doctor Answers (4)

Rhinoplasty for Broken Nose

+1

Hello,

 

  Thank you for including photographs with your question.  It makes having a meaningful discussion a little more realistic.

  I agree with Dr. Hilinski  about finding a good PPO plan that allows you to choose your physician instead of being assigned one through an HMO.  You will have to ask the insurer if they consider this trauma a preexisting condition and how that would impact your copay and deductible.  In San Diego many physicians accept Cigna, Aetna, United Health and Blue Shield.  I would start your search with these providers.  There are doctors that also accept Blue Cross, TriWest and Kaiser, but this may or may not limit your options.  

 

There are 2 types of rhinoplasty surgeries.  Procedures that improve the way that your nose functions, corrects traumatic deformities, or reconstruct defects from cancer, are typically covered by insurance.  There is a big difference in out of pocket cost in having a reconstructive rhinoplasty covered by insurance compared to only the septoplasty portion. 

Rhinoplasties that are purely for cosmetic reasons, dorsal reductions, tip recontouring, nostril reductions are typically not covered by insurance.  

 

Hope this helps.


San Diego Facial Plastic Surgeon
5.0 out of 5 stars 35 reviews

Rhinoplasty and insurance

+1

I'm not sure your approach will be successful.  The problem is that when you get health insurance, there will likely be  a waiting period before they will cover elective surgery.  Most insurance carriers may cover this type of surgery, but they are likely only to pay for the septoplasty part, and not any part they consider cosmetic.  You see, the insurance companies are pretty smart, and believe me, they will make sure in some way, shape, or form that they don't come up on the short side of the stick on this deal.  Don't get me wrong, I think you should have insurance anyway and at your age, it should not be very expensive.  But you will likely have to carry a deductible and co-pay which will have you laying out a fair amount if money in addition to the insurance premiums to have the surgery done.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 11 reviews

How To Find An Insurance Company That Will Cover My Rhinoplasty For Injury Related Reasons?

+1

Most health insurance companies have a prior conditions clause that might dis allow you coverage. In some cases there is a 6 to 12 month delay clause. It is your responsibility to understand all these clauses/restrictions in a health policy before signing on. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 64 reviews

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Septorhinoplasty and Medical Insurance Coverage

+1

Jeff, this is fairly common to have insurance coverage for nose surgery following a traumatic injury. I would suggest you get a solid PPO plan that allows you to choose your surgeon. An HMO plan will limit you to whatever doctors are on their panel, which is usually a narrow choice. I have provided a link below that will give you more information regarding use of health insurance to have this type of surgery performed. 

John M. Hilinski, MD
San Diego Facial Plastic Surgeon
4.5 out of 5 stars 19 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.