Why won't insurance cover my nose job (it's for breathing problems)?

Question

My right nostril is ALWAYS blocked. 24/7. It drives me ABSOLUTELY insane and I have lost my quality of life. I went to an ENT and he said I have a "slight deviated septum to the right", but it was not severe enough so insurance would not cover it. My nose is small and the slight deviation personally causes me a lot of blockage. I just want to be able to breathe freely. In fact I can't focus on anything else because the blocked nostril is so frustrating. What should I do?

Kenneth Hughes, MD · Answer

Insurance plans vary in what they will cover.  You could always get another exam and try the process for approval again.Kenneth Hughes, MDLos Angeles, CA

Stephen Weber MD, FACS · Answer

It's very hard to advise you as to why the procedure was not considered a "covered benefit". If your surgeon called your septal deviation "mild" that might explain it. You could always seek a second opinion. In many cases, surgery to improve nasal breathing is covered but every insurance policy differs with regard to nasal surgery. Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Steven M. Daines, MD, FACS · Answer

Most insurance plans will cover medically necessary surgery to improve nasal breathing. Insurance does not cover surgery to enhance the appearance of your nose. Different plans have specific criteria that must be met in order for nasal breathing surgery (i.e. septoplasty, turbinate reduction, or nasal valve repair) to be covered. If your quality of life is affected by your nasal obstructive symptoms, I recommend you consult with another surgeon for a second opinion.

Gaurav Bharti, MD, FACS · Answer

Each person's insurance carrier will have different coverage policies for something like septoplasty. I suggest discussing this with your insurance company and with your surgeon. Good luck.

Robert E. Zaworski, MD (retired) · Answer

Contact your insurance company to review your benefits for nasal surgery.  Your surgeon will need to write a letter to your insurance company explaining the problem.  They may also request photos.  Best wishes!

Why won't insurance cover my nose job (it's for breathing problems)?

Answers (5)

More Rhinoplasty Questions

I'm 14 yrs old and have droopy nose. Am I too young for a nose job?

Surgeon fees vs anesthesia cost for a facelift or rhinoplasty?

How soon after rhinoplasty can I have breast augmentation surgery?

Doctor said nose is not broken, but there is a bump on the right side. What could it be?

Broken nose still looks crooked after closed Nasal Reduction. Is this normal? (photo)

WE SEND PRETTY
EMAILS