Insurance coverage for nasal valve collapse?

Question

I have never had a nose job/ surgery of any kind but my nose seems to be caved in on the left side. It hasn't always been this way. I don't recall hitting it or anything. My left nostril is almost completely closed off and is driving me mad. I can't breathe through it! Is this something that insurance will cover? It's not cosmetic, I just cannot breathe through it.

Tanveer Janjua, MD · Answer

Nasal valve collapse delete to difficulty breathing through that side of the nose.  That is considered a medical problem and insurance company should essentially cover it.  However, every insurance company has this on policy.  He might have to submit photographs to insurance company to your doctor showing the collapse area.Regards,Dr. J

Anand D. Patel, MD · Answer

If you report a breathing problem and we find a structural abnormality of your nose that is causing the problem, then most insurances will cover a procedure to correct the abnormality. This may include a deviated nasal septum, enlarged turbinates, a internal or external nasal valve collapse, or septal perforation.

John Dean, MD · Answer

Functional nasal surgery can be covered by insurance, depending on your policy and other factors.  Your surgeon will confirm and document your problem, and propose a treatment, such as spreader graft surgery, to your insurance company. They will then tell you if you will be covered by authorizing the surgery.  The surgeons office can handle the insurance issues for you.

Pedram Imani, FRACS, MS, MBBS (Hons) · Answer

Most insurance will cover functional rhinoplasty and septal surgery.  Consult a facial plastic surgeon and proceed from there.  Hope this helps.

William Portuese, MD · Answer

A  thorough examination of the internal and external portion of the nose is required by an ENT/ facial plastic surgeon to determine the cause of nasal obstruction. Valve collapse can be caused from either static or dynamic reasons.  Spreader grafts, alar rim grafts, and alar batten grafts are used to  improve valve collapse. Most medical insurance companies should cover this procedure if it is medically related

Sachin S. Pawar, MD · Answer

In the vast majority of cases, if you have trouble breathing through your nose which is related to a structural issue such as a deviated nasal septum and/or narrowing or collapse of your nasal valve region, surgery will be covered by most insurance plans. I would recommend seeking out a consultation with a facial plastic surgeon for a complete evaluation and discussion of your options. Good luck!

Stephen Weber MD, FACS · Answer

Some insurances cover nasal surgery to help you breathe. Other policies exclude nasal surgery completely. In most cases, insurance will cover procedures that help you breathe but, as you point out, any cosmetic changes are not covered. Your best next step is to schedule a consultation with a rhinoplasty expert. They can submit information about your nasal issues and try to get coverage authorized for a procedure. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Julian W. Dixon, MD · Answer

Thanks for your question. In short yes a severe nasal collapse repair is actually covered by insurance. In addition the septoplasty and other portions of the functional surgery would also be covered. I would encourage you to find an experienced nasal surgeon in your area and get a consultation for more details. Please do your research however because many aesthetic surgeons do not take insurance. Hope this helps.

Harrison C. Putman III, MD (retired) · Answer

It is quite possible that you have more than 1 cause for your nasal obstruction, including nasal valve collapse and very possibly a deviated septum, for example. I would advise an examination by a board certified ENT or facial plastic surgeon to determine the causes. Pre determination is usually performed to confirm insurance benefits, but this can take weeks to complete at times.

Dennis Barek, MD (retired) · Answer

It is commonly asked if a procedure is covered. Rarely do we know what your benefits and coverages are. After you find out what you have, call up your insurance company and ask what type of documentation is required for your problem(s).Sometimes the doctors office will help with obtaining a "pre-determination of benefits".

Insurance coverage for nasal valve collapse?

Answers (11)

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