I have had 4 traumatic experiences with my nose. I am almost 20 years old and after my recent accident happening almost 3 weeks ago, I've been told I have a severe deviated septum and an obvious hump that in bigger than before. My nose is also crooked because when looking me straight in the face, it curves to the right. I was wondering if insurance would be able to cover 100% of the procedure if I had the septoplasty combined with the rhinoplasty. Is that possible?
Is It Possible to Have a Septorhinoplasty Done and Insurance Cover It 100%? (photo)
Doctor Answers 7
Insurance coverage for septorhinoplasty
Medical insurance does not pay for cosmetic changes to the nose or any elective cosmetic surgery. Medically related conditions, such as a deviated septum, turbinate hypertrophy, or valve collapse causing obstructive nasal issues may be submitted to insurance. Medical insurance may also participate for a broken nose. When medical procedures are performed, insurance co-pays and deductibles have to be taken into account, so patients should be prepared to pay some portion of the procedure with an out-of-pocket expense even though it is medically related.
100% Insurance Coverage for Septorhinoplasty
If the cosmetic and functional problems are all secondary to your trauma some insurance companies will pay for the operation. They are also more likely to cover the operation if cosmetic changes will improve nasal breathing. The staff in your surgeon's office can help you contact the insurance company for authorization and and an estimate of benefits.
Some insurance companies will cover septorhinoplasty to improve breathing
Some insurance companies will cover septorhinoplasty to improve breathing. Every insurance company differs, however. Often the request to perform surgery will be denied and you'll be told septorhinoplasty is a "cosmetic" procedure. Often this will be approved on appeal. However, only maneuvers that are done to improve your breathing will be covered. This might include straightening of the nose but will not cover removing a bump from the bridge or changing the appearance of the tip or the look of any other part of the nose. I would recommend seeking an experienced Facial Plastic Surgeon or Plastic Surgeon who does ALOT of rhinoplasty for an in-person consultation.
Thank you for your question.
Stephen Weber MD, FACS
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Septal surgery and insurance
Insurance may or may not cover your problem. Usually with a history of trauma, insurance will cover the septal work and even the bony work if it is well documented. As for a doctor accepting your insurance as full payment, that is something to discuss with the doctor.
Possible to have rhinoplasty 100% covered by insurance?
I am afraid this is wishful thinking. Every area and company is different but in our area and even written into my own personal and family policy it specifically states that any surgery to change the appearance of the nose regardless of the cause (trauma, fracture) is not covered. Only surgery to correct medical function is covered. You may think this includes fixing the hump but they don't. Your septoplasty will likely be covered and you will have to pay in addition for your rhinoplasty. Save your money and get it done right the first time. If you shop enough you might find someone to do it for insurance only but you will end up spending a lot more for the revision.
Septorhinoplaty and insurance coverage
This is a tricky question; in my experience, the septoplasty is often covered because of airway concerns; and some "straightening" would probably occur as result of addressing the previous trauma via "rhinoplasty"; a lot of this would depend on the individual insurance company: how they would view this. Despite the trauma and the fact that these were accidents, they might still view the rhinoplasty as strictly cosmetic. I would certainly pre-determine this with them if possible; also have your plastic surgeon go over with you as much as possible his operative plan; e.g. correcting deviation in the "crooked" nasal bones is part of the rhinoplasty, but if some more work is done e.g. on the nasal tip to provide symmetry or projection for example; could this be considered cosmetic? If the insurance company commits to part of the procedure; your surgeon could give you a separate fee for the "cosmetic" part and this might work for you.
That depends on your insurance and your doctor's findings. Insurance will usually cover (after deductible and co-pay) surgery to restore form (shape) and function (breathing) after a fracture. Many companies will deny coverage on the first go round, so be prepared to argue your case with the insurance company. Insurance will not cover cosmetic surgery.