Is It Ok to Add Something You Want Done in Your Rhinoplasty in Your Pre Op Appointment the Day Before the Surgery?

If you want to change your planned surgery, it is better to schedule a 2nd consult as early as you can to go over what you want to add.  Do not wait until the last minute to inform your surgeon you want to add to what you already discussed. If what you want to add has a medical indication, your surgeon needs time to request pre-authorization. This can take days to weeks. If it is not considered medically necessary, then you will need to pay a cosmetic fee, not only for the surgeons fee, but also for the extra anesthesia and OR time needed to do the additional procedures.  Also, the surgeon may need to adjust the surgery schedule in order to allow enough time for your procedure. Personally, if a rhinoplasty patient told me last minute she wanted to change what was being done, I would wonder if she really knew what she wanted and would prefer she took time to give it some serious thought.  Don't rush into rhinoplasty before you are sure of what you want. Also, there are different varieties of rhinoplasty surgeons. Not all feel comfortable doing extensive tip work. So for many reasons, it's better to discuss your goals with your surgeon early, and make sure you are on the same page. Good luck!

The insurance company needs to be notified about the procedure before it takes place. Otherwise you might be responsible for the uncovered portion of that surgery. Usually the cosmetic part is not covered. You should speak to you surgeon about changes prior the pre-op appointment. One day could not be enough to get some answers from your insurance company. Your plastic surgeon can probably accommodate the cosmetic changes but it may mean more time (and money)

You need to notify your surgeon as soon as possible that you have decided to make a change in the surgery. This will allow adequate time to plan for the surgery, make adjustments in the operating room schedule in case you need more or less operating room time etc.

You say the whole surgery is covered by insurance but health insurance does not cover dorsal hump removal unless it is the result of documented trauma. They only cover reconstruction for documented trauma and structural problems causing nasal airway obstruction. A dorsal hump does not usually fall into any of those categories and so its removal is not usually covered. Just because the insurance company says it will cover something before surgery does not always mean they will do so after it is billed. If they later suspect it was a non-covered procedure they will not pay and you will be responsible for the payment. Given your belief that they will cover the tip modification as well your whole case is suspiciously one of insurance being billed for non-covered procedures.

If part of a nasal procedure is reconstructive work and part is cosmetic they only pay for the reconstructive component. They will not even pay for the operating room or anesthesia time devoted to the cosmetic part.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

It's always better to discuss your goals well before surgery. Call the office and tell them your concerns and see if the surgeon can see you sooner. Don't expect the insurance to cover any cosmetic changes you want in the tip. That would be cosmetic and your responsibility. Insurance pays for things that are medically necessary.

You should contact your rhinoplasty surgeon immediately and make arrangements for another follow-up consultation.  It is very important that you both agree on the plan.  An excellent time to have another computer imaging session, so that you can see the predicted result that the doctor believes will fulfill your wishes. 

Regarding the insurance issue, obviously, you will have to contact your insurance company and check with the doctor's business manager to find out what else has to be done administratively.

It is always better to have everything in place well before the day before rhinoplasty surgery.  That way, your doctor will have all his notes, photographs, computer imaging, and all the documents necessary for him to execute the maneuvers necessary to get you the result you want.

Good luck!

Robert Kotler, MD, FACS
Facial Plastic Surgeon
Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON

Adding to the originally planned procedure, should you and your PS agree that it is reasonable, will require more time in the operating room, it may not be covered by the insurance company because they might deem it to be cosmetic (thus added out of pocket cost to you) and will require added informed consent from you. You may have to have your procedure rescheduled.

I would strongly recommend you reconsult with your surgeon.  He must plan for your nasal surgery.  It is unlikely that insurance will cover the cosmetic portion of your surgery.  Your surgeon's office will need time to check your eligibility and benefits with your insurance company.  Warmest regards.

Dr. Pippin

The sooner you make your wishes known the better. Your doctor will need to schedule more time. As for the insurance issue, I can't answer that. that depends on how the approval was obtained

It would be best for you to discuss this with your surgeon as soon as possible.  There are multiple factors that go into an operation and most surgeons go into surgery with a plan that is carefully thought out beforehand after extensive discussion with you.  From what you describe, you would need more operating time which means that the surgeon needs to block out more time in his/her schedule, the operating room, the anesthesiologist's schedule, etc.  Additionally, you need to discuss if there are any financial issues that need to be worked out beforehand as insurance will not cover aesthetic changes.

Sometimes it is necessary to change the surgical plan for a rhinoplasty  when the patient is seen the day before surgery; for example when the patient is from another state or country. I prefer that the patient have more time to consider the proposed modifications. It is unlikely the tip work will impact the insurance payment, which will not cover the cosmetic procedures. You may have additional personal financial responsibility.