Can health insurance cover surgery for a broken nose?

About two weeks ago I broke my nose, I can hardly breathe out of it anymore and a large bump has formed on it because of this. I want to know that if I can get surgery, is it going to reshape my nose and get rid of the bump? Or are they going to keep it there? On top of this, do I have to pay myself or will my insurance cover it?

Doctor Answers 5

Insurance Will Cover Fracture Repair

In general, insurance will cover the repair of a nasal fracture, which often includes correction of the septum. If you have a new bump after the fracture, the correction of that should also be covered. Two weeks after the injury, you should be examined to make sure that the inability to breathe is just swelling and possible septal deviation, rather than a collection of blood underneath the septal mucosa. (In such a case, it would need to be drained to avoid septum destruction and nasal collapse.) The timing should be at least 3 months after the injury to let the swelling and inflammation subside. Reshaping the nasal tip, if desired, is not part of what insurance will cover

Health insurance coverage for broken nose

It is possible to obtain coverage for a broken nose by your medical insurance. A thorough documentation of the injury, along with x-rays, and a comprehensive internal and external termination of the nose for coverage is required. Medical necessity must be documented at the time of the consultation and examination. In addition to the nature of the injury, each in insurance has different determinations about eligibility/benefits. It's always best  to check with your insurance booklet specific to your medical Health insurance policy. Co-pays and  Deductibles still apply even for medical necessity. Surgical free-nation should be performed by the physician's office prior to the surgery. For more information and many examples of broken nose repair in our practice, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 reviews

Broken nose treatment

If you've broken your nose 2 weeks ago, you need to see a surgeon ASAP. It may be possible to minimise the need for, or extent of, future rhinoplasty surgery by having your broken nose 'set' properly. This would best be done this week. 

Mark Baldwin, MBBS
Melbourne Plastic Surgeon
5.0 out of 5 stars 12 reviews

Rhinoplasty and Insurance

Sorry to hear about your trauma to your nose!Insurance will cover a "functional rhinoplasty" sometimes.  It depends on the insurance carrier and a few other factors.  Usually the insurance company needs to see that you have failed "maximal medical therapy."   In my patients, we try to use saline spray and a steroid nasal spray (both over the counter) for several months to see if this helps.  If it doesn't and breathing is still obstructed we try to get the surgery to correct breathing approved by insurance. Some people would like some cosmetic changes too and are willing to pay out of pocket for the additional work. It can be a process, but worth it if you can't breathe from your nose!Make an appointment with a facial plastic surgeon to get startedBest of luckDr Rodman

Regina Rodman, MD
Houston Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Depends on multiple factors

Insurance coverage for nasal surgery depends on a number of different factors, like your particular plan and coverage, extent of injury and breathing problems, and medical necessity.  Also, some of the correction may be covered by your insurance plan, but if you are seek some other cosmetic changes to your nose at the same time, you may have to pay out of pocket for that.  The first step would be to seek out and have a consultation with a double-board certified facial plastic surgeon to see what is going on both externally and internally with your nose. 

Jason D. Bloom, MD
Philadelphia Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.