Would insurance cover fixing my nose if I broke it a while ago?

Question

I've had breathing problems for a while. I recently saw an ENT who said I have a deviated septum. I also broke my nose a few years back and it's been crooked ever since but lacked the insurance and money to fix it. I didn't see a doctor at the time. I found a document from current my insurance company stating rhinoplasty due to documented trauma is covered. I recently saw a local Ent/Plastic Surgeon who said fixing the septum would be covered but making the nose straight would not. Was he wrong?

Alexander Donath, MD, FACS · Answer

Typically a fracture repair and deviated septum are covered by insurance but cosmetic changes, such as those which do not appear to be related to the injury, are not.  Differentiating between these would require at least an in-office evaluation.Hope that helps and best wishes,Dr. Donath

Philip Solomon, MD, FRCS · Answer

Insurance often covers correcting medical conditions such as nasal trauma and breathing problem .   Insurance does not commonly cover cosmetic nasal surgery. Combined cosmetic and  reconstructive procedures are  often carried out where insurance pays the reconstructive portion of surgery and there are additional fees for cosmetic alterations to the nose.

Scott Trimas, MD · Answer

Typically, most insurance companies will pay for straightening a broken nose as well as correcting breathing problems. That presumes that you do not have a preexisting clause with your insurance coverage. That being said there may be deductibles and copays involved. Also, it may depend upon your surgeon and if you are having aesthetic things done beside just straightening your nose that could account for some additional costs. I would speak to your insurance and the doctor's office and get more information on the matter.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  Most insurance providers will cover a septoplasty and spreader to help improve breathing.  Cosmetic procedures are out-of-pocket expenses.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Sean R. Weiss, MD, FACS · Answer

Most insurance companies will not cover rhinoplasty procedures that are for cosmetic purposes. Acute trauma is typically covered, but trauma from the distant past may not be. The procedure may be covered if it is for restoring functional breathing.  Usually the functional concerns involve the septum and that is why insurance may cover this and not the rest of the procedure. Fixing the crooked nose is usually considered cosmetic. You can look into your insurance companies policy on covering nasal surgery for more details on what they will cover and what criteria must be met for them to do so. Best Regards, Dr. Weiss

Payam Daneshrad, MD · Answer

Traditionally, insurance companies will pay for the functional portions of your surgery. This will allow you to breathe better. When it comes to the cosmetic changes, it all depends on what you are trying to achieve. Just straightening might be covered but anything more and you will probably have to pay for your surgery yourself.

Robert S. Schmidt, MD · Answer

Thanks for your question. This is a very common issue in my practice. Almost always if you broke your nose (especially if you have documentation of it like an old ER visit or something), and now it's crooked and you're having breathing difficulty, you should be able to file for insurance coverage for the whole thing. You would need a septoplasty and what we call an "open reduction of nasal fracture." Now, if you wanted tip work or something, that would be a different matter. It also varies by insurance company, but if you've checked into your individual situation, then I don't see what the problem would be.For an example of exactly this kind of thing, check out this example from my photo gallery. Good luck!

Would insurance cover fixing my nose if I broke it a while ago?

Answers (7)

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