Insurance Coverage for Fixing Broken Nose?

Insurance generally covers procedures that are to improve function and your health, but not those that are just for aesthetic purposes. It sounds like yours is for aesthetic purposes, therefore chances are insurance won't cover it (although a portion of it may be covered).To fix your nose, scars are generally placed in discreet locations so you don't have to worry about having a visible scar.

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.  Typically insurance will not cover a broken nose for cosmetic reasons as there is no functional deficit with these fractures.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!
Best wishes!

It is unlikely that an insurance company will pay for the surgery. Usually, insurance companies will ask for the following when someone submits a claim for a broken nose:
1. Emergency room report at the time of injury
2. CT scan which shows broken bones.
3. A report from a qualified doctor saying that the injury is causing some kind of breathing difficulty.
It is unlikely you can have insurance pay unless you have this information.

Hi,
Thank you for your question.
This is a tough situation. There are several things goin on. It seems as though this is more of a cosmetic procedure which insurance does not cover. Plastic surgery procedures have to be determined medically necessary in order for insurance companies to cover the procedures. Even then, some insurances, especially Medicare/Medicaid, do not cover them fully.
It does not seem like this is medically necessary in your case, especially since it has been over a year and a half and you can breathe just fine. Medicare also does not pre-certify, so they never guarantee procedures, even in the most necessary cases. It would be difficult to find a surgeon who would take the risk of performing the surgery and not receiving payment.
Your story is not completely hopeless, however. Many plastic surgeons offer financing such as Care Credit where you can pay montly payments. Some may even offer payment plans in their office. Depending on what exact procedure you need, this may be an affordable option for you as it would obviously be worth it to you.
Best regards,
Dr. speron

Insurance is a contract between you and an insurance company. Your Doctor has nothing to do with the process and will expect to be paid by you. Surgeons fees vary depending on the level of expertise, so you may find variation if you seek more than one consultation.

This is one are in life where it pays to pay retail. Evaluate the surgeon, and their credentials as well as the years of experience.

If you choose to submit the bill for services to a third party, that is your own choice and I suggest you contact whomever that might be with further questions. Insurance companies make money by not paying bills, and the fewer bills they pay, the more money they make.

Despite attempts to regulate insurance companies, they routinely flaunt the law and occasionally will be fined. Relatively small fines are part of their business plan, which maximizes their profit. One example is the misuse of the Ingenix data, try Googleing the words Ingenix and United Healthcare NY attorney general. You will see just one of many examples, where data was intentionally manipulated to lower reimbursement rates.

 

Fixing a broken nose is routinely done and is usually covered by the insurance company. However, in order for this to occur, you may need a report from the emergency room that you visited after getting the broken nose along with a CT scan demonstrating the fracture. Otherwise, it may be difficult to convince the insurance company that it's not cosmetic. Good luck!

Hello,
Your situation is not unique and you have a LOT of good answers to your question from other doctors. They parallel my opinions. If you have pictures of how you looked before the injury this can help your case.
As I see it, your real outlet is to go to a teaching Hospital as recommended by the other responders unless you are going to pay for the procedure.

 Teaching hospitals probably offer your best option. The resident surgeons are supervised by a teaching plastic surgeon. The outcome is quite satisfactory in most cases.

With most insurance companies, it is possible to compose a letter to determine if they will cover the cost of surgery prior to performing the actual procedure. Unfortunately this is not possible, at least not in the state of Illinois. Therefore, you will have to find a surgeon that is willing to take a chance and bill afterwards to see if it is a covered procedure. Not many surgeons are willing to take this chance. However, you can call around and ask some questions. Medicare may cover a functional procedure but it may not cover a reconstructive and certainly will not cover a cosmetic procedure

Your insurance will not pay for just fixing a broken nose that has been broken a long time ago unless it is causing a breathing problem. There is no medical necessity to fix this other than any cosmetic purposes. This is a cosmetic rhinoplasty, and insurance will not pay for this type of straightening of the nasal bones.