Insurance coverage for deviated septum
Insurances do cover for a functional problem as the case with a deviated septum but not all the time. At times they require documentation with an imaging study such as a CT-Scan.
You should check with your insurance company to see if your plan covers deviated septum. Some insurance companies exclude procedures, so far I have not come across one that excludes deviated septum.
Insurance coverage for septorhinoplasty
Generally, insurance will cover the functional portion of your surgery as long as your condition and the degree of nasal obstruction, and alternatives to surgery have been well documented by your surgeon. The insurance company may even elect to cover the nasal fracture portion of your procedure. If the fracture is old, it will likely be treated as a cosmetic condition and coverage is very unlikely. There are still advantages to having your nose fixed the way you want it if you are considering undergoing functional repair for breathing. First, it is one surgery and often times the septal cartilage that is being repaired can also be used to treat some of the cosmetic deficiencies of the nose.
Second, although your insurance will not cover the cosmetic portion of the nose, they will cover a great deal of the surgical center fees and the cost of the anesthesiologist. This will help to bring down the cost of having your nose fixed without any insurance coverage by a significant amount.
In terms of getting back to your work outs, I suggest being patient. Once you have committed the time, energy, and expense to having your nose fixed, you should be careful to enable the healing process to take place flawlessly. I advise against significant physical activity for about three weeks (although this will also depend on the degree of work performed on the nose) and then a gradual increase in exercise level for the next couple of weeks.
It never hurts to ask... Seek authorization, but don't expect 100% coverage.
It’s not unreasonable to seek prior authorization from
insurance carriers for both rhinoplasty and septoplasty performed simultaneously. Post traumatic deformities of the nose and
deviated nasal septum’s can both be caused by trauma and both problems may
therefore be covered by insurance.
is often covered by insurance, especially when nasal airway obstruction is
present.Under these circumstances, this
represents a functional problem. Rarely
insurance covers reconstructive rhinoplasty as a restorative procedure.
cases, insurance carriers approve septoplasty, while denying benefits for
rhinoplasty. In this situation, nothing is lost by running the rhinoplasty
through insurance. For this reason,
there’s no reason not to seek prior authorization for both procedures, if
there’s any question about insurance coverage.
Insurance coverage for deviated nasal septum and crooked nose
Insurance will generally cover surgery to correct problems with the function of the nose such as breathing issues. A crooked nose may contribute to difficulty breathing depending on the location of the deviation. Sometimes correction will result in a better looking nose as a result, but not always. Surgery with the intent to change the shape of the nose to improve the appearance is cosmetic and not covered by insurance and would be an out of pocket expense. These procedures are commonly combined and performed at the same time. Speak to a rhinoplasty expert who also specializes in functional work to be evaluated and collaborate on a plan for your nose.
Insurance generally covers procedures that are to improve function and your health, but not those that are just for aesthetic purposes. You should ask your provider directly.
Breathing problem surgeries are covered by Insurance
Breathing problems are caused by a number of structural changes within the nose. The septum (the partition between the right and left nostril) can be shifted, or deviated from one side to the other narrowing the nasal passage. Furthermore, in the case of a broken nose, the nasal bones may be pushed in words and narrowing the nasal passageway. Finally, there are "valves" and "warming and filtering organs" within the nose that may be impaired and require reconstruction.
All of these procedures are typically covered by insurance however different insurance companies require different preliminary or prerequisite treatments or tests before they will agree to pay for the procedure.
By all means seek a consultation and ask your insurance representative if they cover the procedure that your surgeon recommends.
Insurance coverage for correcting deviated septum and crooked nose?
Hello! Thank you for your question! Surgical procedures for aesthetic
purposes, to improve appearance, are not covered by insurance.
Typically, these as well as complications resulting from such procedures
are the responsibility of the patient. Procedures that are meant to
correct functional issues and those which cause health-related issues
should be covered by your insurance as a medical necessity, with proper
examination and documentation. Some insurance plans have exclusion
criteria for certain procedures. Also, it is an obligation of the
surgeon not to attempt to authorize purely cosmetic procedures through
insurance. The septoplasty, but not the rhinoplasty, may get covered.
Discuss your issues and
complaints with a board-certified plastic surgeon to discuss these as
well as to examine and assist you in deciding which procedure(s) will be
the best for you. A discussion of the advantages and disadvantages will
take place along with the risks and benefits. Insurance companies will
vary on coverage and is always reasonable to discuss your issues with
your surgeon and primary care. It would behoove you to get as much
information as possible and even call your insurance yourself.
Certainly, pay in advance prior to your surgical procedure and options
such as financing are available if you qualify. Hope that this helps!
Insurance coverage for deviated septum and crooked nose correction
Medical Insurance has literally become a criminal scheme in which you / your parents/ employer pay a company with the understanding that IF you have a condition listed ON YOUR POLICY they and you will pay a doctor / hospital an agreed amount to correct it.
Human nature being what it is all sides cheat or push the envelope. Patients want EVERYTHING to be "covered" regardless of what they / the employer paid without any out of pocket expenses while insurance companies want to hold on to the money for as long as possible by using EVERY KIND OF PRETEXT you can imagine.
As surgeons we are caught in the middle. Each insurer has many different policies (IE MEDICAL MENUS) - each "covers" different conditions. There is NO WAY that if you paid for the "Economy" policy - you can talk your insurer to look the other way while they pay for treatments (IE dishes, in this analogy) you did not pay for. As a matter of fact, they frequently screw holders of "First Class" policies with delays. claims of pre-existing conditions, need to document "conservative care", lost photographs etc.
Your insurance is a contract between you and the insurer - not between the doctor and the insurer. As such, if you want your insurer to cover a cosmetic procedure (the nose repair) you will have to EITHER pay the surgeon out of pocket and try submitting his/her bill to the insurer afterward OR you will spend a lot of time on the phone and writing with a VERY small chance of success.
Bottom line, in almost any state of the union a Septoplasty MAY be authorized (subject to your meeting different requirements) but the nose repair would not be.
Things will NOT improve and will get worse so you may want to get it done now.
Insurance covers medically necessary nasal surgery
Surgery for a deviated septum is typically covered by medical insurance since it is done out of medical necessity. A broken nose is sometimes covered if it is creating a breathing issue whereby both nasal bones are twisted over the upper lateral cartilages or fractured off the nasal bones causing the upper lateral cartilage to be pushed down into the airway, causing nasal obstruction called valve collapse or vestibular stenosis. It might be best to wait until you have completed playing sports, so as not to get hit in the nose. In regards to recovery after a rhinoplasty and deviated septum surgery, it is important to not work out for two weeks after surgery, and no contact sports for one month. Insurance coverage for this type of surgery must be first documented by your physician for medical necessity and then pre-authorization is also performed prior to the surgery. For many examples, please see the link below to our rhinoplasty photo gallery
Rhinoplasty and septoplasty
Insurance will typically cover the "reconstructive" component of the surgery which is the septoplasty, to improve your breathing. Insurance will not typically cover the "cosmetic" portion, which is the crooked nose straightening. Coverage varies greatly according to your specific health care plan, so discuss this in detail with your surgeon and insurance company to get "preauthorized". This will determine which portion and how much of the surgery they will cover for you.