When Septoplasty/Rhinoplasty Are BOTH Medically Necessary How Do You Get Coverage?

asked 8 months ago by shelli.kent
Latest answer by Richard W. Fleming, MD
Question viewed 194 times
Tags: crooked, breathing problems, insurance, septorhinoplasty

When both Septoplasty/Rhinoplasty are BOTH medically necessary how do u get coverage from your insurance? My ENT says due to the fact that the bone in my nose is crooked and blocking my breathing as well as the exterior end of my nose is also crooked and blocks my breathing, I would need both at the same time to correct my breathing function. Trying to only do Septoplasty will not correct my problem?

9 answers to When Septoplasty/Rhinoplasty Are BOTH Medically Necessary How Do You Get Coverage?

Insurance Coverage for Septorhinoplasty to Correct Breathing

The staff in your surgeon's office can help you contact your insurance company to explain your problem and the proposed surgery so you can get pre-operative authorization. Many policies do cover operations to improve nasal breathing, but many times it is difficult to get the company to tell you what they will pay.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon

Septorhinoplasty

Your surgeon must obtain preauthorization and establish functional medical necessity for both parts. However, insurance companies now have wonderful rules that prohibit payment for two procedures through the same incision which effectively means that there will be no reimbursement for the lesser included procedure. Please know that, even if your doctor is out of network, the same rules apply so you should clarify your financial responsibility in advance. In some cases, I perform septolasty... more

Robert L. Kraft, MD
New York Plastic Surgeon

Insurance coverage for rhinoplasty

Simply put, insurances cover only medically necessary procedures, and all cosmetic surgery is an exclusion from coverage. There is a procedure code for rhinoplasty, and if a patient calls his/ her insurance and simply asks whether rhinoplasty surgery is a covered servce, the answer most likely would be "yes, if it is deemed medically necessary by your doctor". In reality, medically necessary rhinoplasties are few and far in between: correction of congenital deformities, severe... more

Alexander Ovchinsky, MD
New York Facial Plastic Surgeon

plasticsurgeryofshorthills.com

A Crooked and Blocked Nose Usually Needs Septoplasty + Rhinoplasty

Greetings, Shelli. A crooked nose that does not breathe well is best managed by functional nasal reconstruction. Whether or not the insurance company pays for such depends on the report your surgeon submits. Typically, insurers do pay for such reconstructive surgery because it is not purely cosmetic. There is the poor breathing and there is the deformity on the outside. Probably both related; perhaps you had an injury when younger. Here is my advice: consult an experienced nasal... more

Robert Kotler, MD
Beverly Hills Facial Plastic Surgeon

Medically necessary rhinoplasty

This is a common complaint and frustration for many patients and their physicians. While there may be no way to adequately fix your breathing without doing some rhinoplasty work insurance companies will still not pay. There is nothing your physician can do to "convince them of the necessity" and even getting preauthorization means nothing. Any claim submitted with rhinoplasty codes in it is a red flag for them. They will request the records and simply not pay. They are for... more

Michael L. Schwartz, MD
West Palm Beach Plastic Surgeon

www.palmbeachface.com

Septorhinoplasty

IF your surgeon has deemed that both are medical necessary for functional reasons, he/she will usually obtain a preauthorization with your insurance company. Insurance companies will not cover any cosmetic changes or improvements to your nose. This process takes some time, so be patient!

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon

Insurance and rhinoplasty

Insurance does not cover rhinoplasty.Insurance will cover functional obstruction and problems related to it.

Jay M. Pensler, MD
Chicago Plastic Surgeon

www.plasticsurg.org

Insurance coverage for septo-rhinoplasty

Although most insurance companies will cover correction of functional breathing problems of the nose and reconstruction after injury, the exact details of that coverage varies. Often their is a "gray area" for the insurance of what is reconstructive and what is cosmetic. Before your procedure, your surgeon will get preauthorization from your insurance company. This will list exactly what will and won't be covered. It is not unusual in rhinoplasty surgery... more

Adam Hamawy, MD
Westchester Plastic Surgeon

What does insurance cover in nasal surgery?

This is a common question. Insurance companies generally cover procedures that are medically necessary. For nasal surgery this includes problems related to breathing. A deviated septum and enlarged turbinates can lead to difficulty breathing (obstruction of nasal airway) and thus are usually covered. If the nose is severely crooked, or if there is collapse of nasal valves (cartilage support), these can also be covered. Insurance plans will not pay for improvement in the appearance of the... more