I always have allergies yearly. Can never breath properly because of congestion. I want a rhinoplasty not only functionally but mainly cosmetically. My expectations are that I want my tip reduced and elevated, my bridge shaved, and nose brought in closer to my face. Is there a way I can get purely cosmetic procedure covered by insurance? Can you judge my picture if there is anything wrong internally with my nose ? Is there a way I can test on myself if I have a deviated symptom?
Can I Get my Rhinoplasty Covered by Insurance? (photo)
Doctor Answers 10
Medical insurance and rhinoplasty
Rhinoplasty is considered a cosmetic procedure and is not billed to insurance. Insurance will only cover medically related issues such as a deviated septum, if present, and nasal breathing issues. Control of allergies is important, using medications like nasal sprays, antihistamines, and decongestants to control turbinate hypertrophy. When medications no longer address the breathing issues, consideration for improvement through surgery can be made.
Rhinoplasty covered by insurance?
This is a common question at our practice. Insurance may or may not cover functional problems. However if you would like to change the shape or size, it’ll be consider cosmetic. Insurance does not cover cosmetic procedures.
Nasal surgery for allergies
Insurance will not pay for the cosmetic portion of the procedure but will probably pay for correction of breathing problems you have. You may need reduction of your nasal turbinates ( tissue inside the nose ) or a septoplasty as part of your surgery. Insurance may pay for that portion but you will certainly be out of pocket a good amount of money for the cosmetic part, probably at least $5000.
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It may be a violation to have your functional issues covered by your insurance during rhinoplasty surgery.
Great question. Many patients may visit me for a consultation desiring both aesthetic changes in the appearance of their noses, and improved nasal breathing. Depending where your surgery would be performed, functional nasal issues may or may not be covered by insurance.
In general, if your surgeon operates, as I do, in facilities that accept Medicare, your surgeon's dictation must be compliant with new ObamaCare / CMS guidelines. The newly formed Health Information Technology Teams (previously medical records department), scrutinize dictations and will not allow separation of functional and cosmetic components of your surgery onto two separate documents. One surgeon performing both cosmetic and functional nasal reconstruction are mandated to dictate both portions on the same document. In my experience, that has led to non-reimbursement of the facility, and significant aggravation for some of my patients.
If your surgeon uses a "government-free" surgicenter, your functional components may be covered.
Hope this is helpful, and thanks again for the query.
Insurance Coverage for Rhinoplasty
Insurance will pay for the correction of functional (breathing) problems but not for cosmetic changes. Consult with an experienced nasal surgeon who can help you discuss coverage with your insurance company.
Nasal surgery and insurance coverage.
Insurance will cover the following types of nasal surgery:
- The functional component of nasal surgery. In other words, the procedures directed at correcting anatomic deformities that may be contributing to airway obstruction such as septum deviation, deviation of the bone-cartilage pyramid, narrowing of the internal or external nasal valve.
- Repair of congenital deformities such as cleft lip nasal abnormalities.
- Reconstruction of nasal defects resulting from tumor removal.
In situations where the individual desires cosmetic nasal reshaping and is also experiencing obstruction which is directly related to anatomic abnormalities as described above, then insurance will cover the functional parts of the surgery. In order to determine if this is the situation in your specfic case, a physical examination of the internal parts of the nose is required.
Mario J. Imola, MD, DDS, FRCSC.
Insurance never covers cosmetic rhinoplasty surgery
Insurance never covers the costs of any cosmetic procedure. If you are having nasal airway obstruction problems then it is possible in some cases to have this portion of the procedure covered by your insurance. Without an examination there is no way to determine if you have a deviated septum or other condition that would obstruct your nasal airway.
Insurance, unfortunately, never covers cosmetic rhinoplasty
Insurance, unfortunately, never covers cosmetic rhinoplasty. If you have nasal obstruction resulting from a problem with the anatomy of your nose, your insurance carrier will likely cover a procedure to help you breathe. This procedure will not change the appearance of your nose but will help you breathe better. If you also want to change the appearance of your nose, that portion of the procedure would be an out of pocket expense. I hope this information is helpful.
Stephen Weber MD, FACS
Rhinoplasty and Insurance Coverage
Thank you for including photographs with your question. It makes having a meaningful discussion a little more realistic.
Generally speaking 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. Not being able to breathe through your nose is potentially an insurance covered condition. Keep in mind that allergy-induced inflammation of the mucosa throughout the nose and sinuses will not improve with surgery. It is important to meet with someone to determine if your nasal obstruction is due to anatomical causes that require surgery or inflammatory causes that are better treated with medication.
Rhinoplasties that are purely for cosmetic reasons, dorsal reductions, tip recontouring, nostril reductions are typically not covered by insurance.
Hope this helps.
A Deviated septum is just one aspect of possible causes of nasal congestion
Thank you for the questions.
1. First of all, the "purely cosmetic" rhinoplasty will not have insurance coverage, but it is possible to reduce your costs in some cases by checking with your insurance to cover just the functional problems.
2. The picture does not give information about your nose "internally". A nasal endoscope is often used to evaluate that aspect.
3. There is no way for you to test for a deviated septum, but you could try to apply nasal breath strips to your nostrils before your consult. Take notes of any improvement you fell when using them.