Crooked Nose: Covered by Insurance? (photo)

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.  Insurance may cover the septoplasty, but not the rhinoplasty portion.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’s
not unreasonable to seek prior authorization from insurance carriers for both
rhinoplasty and septoplasty simultaneously. Post traumatic deformities of the nose
and deviated septum’s can both be caused by trauma and both problems may
therefore be covered by insurance.

                  It’s
not unusual for septoplasty to be covered by insurance, especially when nasal
airway obstruction is present. Under these circumstances, this represents a
functional problem. Rarely insurance covers reconstructive rhinoplasty as a
restorative procedure.

                  In
some cases, insurance carriers approve septoplasty, while denying benefits for
rhinoplasty. In this situation nothing is lost by running the rhinoplasty
through insurance. For this reason, there’s no reason, not to seek prior
authorization for both procedures if there’s any question about insurance
coverage.

                  Following
rhinoplasty, patients are eager to resume their normal exercise routine.
Unfortunately, any maneuver that elevates blood pressure in the immediate
post-operative period can result in bleeding. For this reason, strenuous
activities should be avoided for six to eight weeks following rhinoplasty and
septoplasty. 

You need to have your nose fully examined by a specialist with a thorough understanding of nasal obstruction correction to see what can be done to help your breathing and smell.

Insurance can cover functional surgery to help with chronic congestion. This would include septoplasty, turbinate reduction, alar batten grafts and/or spreader grafts. 

Insurance doesn't cover surgery to correct tip bulbosity or a bump, but this can be done at the same time as functional surgery if you want.

You are certaqinly a good candidate for a rhinoplasty based in your photos.  What needs to be done to improve your breathing cna only be assessed by a physical exam.  As far as whether insurance would cover all or part of the cost depends on a number of issues.  If the crookedness is the result of an injury, insurance would bmore likely to cover the cost.  If not, they may cover only the part involving your breathing, but not any  cosmetic alterations.  You should check with your insurnace carrier to determine their policy, then consult with a surgeon who can assess your situation and obtain insurance preauthorization.

Rhinoplasty with septum, etc. is covered by insurance for crooked noses. They will pay for anything that obstructs the airway, but not any cosmetic part.

A crooked nose is only paid for by insurance when it is due to a nasal fracture.  Breathing related surgery is also a covered medical condition.  Any cosmetic surgery must be paid for by the patient, it is not billed to insurance.  A deviated septum can cause nasal obstruction and a decreased sense of smell due to the lack of airflow up into the highest portion of the nose where the sense of smell organ exists.  It is possible to perform both functional and cosmetic surgery at the same time, but the patients are required to pay for the cosmetic portion separately.

Hi J18;

Your crooked nose looks like it was due to an accident.  If you cannot breathe, then it does, indeed, make sense that you probably have an internally deviated septum, which is probably also the cause of your external crookedness.  Certainly, your nose looks like it.  The sense of smell can also be affected by poor breathing. 

You said that you, "told your doctor…, but she does not think it is serious enough for surgery."  Was the doctor a specialist in nasal surgery?  Or was this your personal doctor?  If the doctor was a family practitioner internist, I think the wise thing to do would be to realize that she may not be an expert, and that you need to consult with a specialist who is.  That specialist would be one who does considerable nasal surgery - both cosmetic and functional - in their practice.  Look for a board certified head and neck (ear, nose, & throat) specialist, or a board certified plastic surgeon specialist. 

With respect to insurance covering your surgery, understand that insurance covers surgery to improve function, such as to improve your breathing or correct allergies and sinus problems.  It does not pay for purely cosmetic changes like reducing the bulbosity of your tip.  Frankly, it pays to combine the procedures because, at least, you will have the benefit of the insurance coverage for a portion of the surgery.

Be sure to have your insurance agent or employer check with your insurer to find out the benefits for the correction of the deviated septum and any other surgery.  The cosmetic rhinoplasty  part will be your treat to yourself. 

Robert Kotler, MD, FACS
Facial Plastic Surgeon
Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON
Author, THE ESSENTIAL COSMETIC SURGERY COMPANION

At best, insurance companies will cover surgery related to the breathing issues regarding your nose such as the septum. They will not cover anything that constitutes cosmetic surgery such as fixing your bulbous tip.

You should go to a board certified plastic surgeon who could assess your situation and them make the appropriate recommendations.

it is very difficult to get nasal surgery covered by insurance. Documentation with CT's are sometimes necessary. If you are lucjy they may cover the septal work. Any aesthetic improvement is self-pay.

Your posted photos look like you sustained a frontal blunt trauma to your nose. If that is the case and especially if it is documented in your medical records the entire surgery would be covered by insurance. In the absence of that insurance will only cover the part of surgery that restores your breathing.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.