Crooked Nose and Trouble Breathing, Will Insurance Cover Surgery? (photo)

Insurance generally covers procedures that are to improve function and your health, but not those that are just for aesthetic purposes. Therefore, there is a good chance that your surgery would be covered, or at least a portion of it.

Insurances will typically cover procedures to help improve nasal obstruction.  The extent of coverage varies based on the details of the insurance plan.  Insurance will not cover procedures that address nasal asymmetry but are not necessary to improve nasal obstruction.

Insurance DOES typically cover nasal surgery to improve nasal breathing. If your breathing issue is related to a prior injury and crookedness of your nose, repair of this is likely covered. However, insurance companies are all different and unfortunately not always ruled by common sense. You should seek an in office evaluation with a board certified Facial Plastic Surgeon or Plastic Surgeon. They will need to submit their evaluation to your insurance company and, in some cases, provide additional information to support their assessment that your nasal breathing issues are caused by the deviation of your nose.Stephen Weber MD, FACS

Insurance often can cover surgery to striaghten the nose if it is causing nasal obstruction. You would need to have your nose examined to determine what actually needs to be done to correct the problem. Your surgeon's office would then be able to obtain pre-authorization from your insurance to see if they will cover your surgery.

If you have medical record documented obstruction to nasal airflow your health insurance will cover surgery to restore airflow. To make sure that you are covered you need to have your surgeon send a preauthorization letter to your insurance company before surgery. Make sure you get a letter from the insurance company stating that the proposed surgery is medically necessary and covered before you proceed. If you fail to do it that way you may end up having to pay for surgery, hospital operating room and anesthesia out of your own pocket.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

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.

Insurance will cover nasal obstruction for the deviated nose. Straightening and opening of your airway will be covered.

Most insurance companies cover straightening of a crooked and broken nose that is causing a breathing issue.  The insurance company, out of medical necessity will also cover the internal breathing component of the nose.  This may include septoplasty, turbinate surgery, or a spreader graft for the concaved side of the nose where it is collapsed inward.  Any cosmetic changes to the nose would need to be paid for by the patient.  As long as all of these procedures are breathing related, most medical insurance plans will cover the procedure.  Remember that patients also have co-pays and deductibles.

The best way to address your concerns is to have a board certified specialist evaluate the underlying anatomy of your nose to determine what anatomic issues are contributing to your difficulty breathing in addition to any cosmetic concerns.  Generally, insurance will only cover the functional or anatomic issues that are preventing you from breathing, not any cosmetic issues.  From what you describe, you may have a component of your anatomy contributing to your crooked nose.

Insurance will usually pay for treatment of a crooked nose and breathing obstruction. Your surgeon's office can contact your insurance company to determine coverage and try to get a pre-surgical authorization.