Why will insurance not pay for a broken nose when I need eyeglasses which will not fit on my broken (very broken) nose?

Question

How can I get help with this as I need glasses?

Manish H. Shah, MD, FACS · Answer

Hello SeanBaxter,Using insurance to cover the reconstruction of a previously broken nose can be tricky!Make sure that your policy allows for nasal fracture repair coverage.  This will be in your insurance policy explanation of benefits.  If you ask your surgeon for CPT codes, you can call your insurance company to see if they cover those codes.If the reason for repair can be deemed cosmetic, they typically won't cover it.  However, if it is considered a reconstructive/functional operation to restore breathing capabilities damaged by the nasal trauma, then you stand a better chance of it being covered by your insurance.I would consult with a board-certified plastic surgeon or facial plastic surgeon and have them fully evaluate you.  You can then put in a request for coverage of a reconstructive rhinoplasty procedure and see if they accept it or not.  If they don't accept it, you can then submit an appeal and have your surgeon speak with the medical director of your insurance program to argue your case.Good luck,Dr. Shah

Stephen Weber MD, FACS · Answer

In most cases, the reasons why insurance companies deny nasal fracture repair are cryptic. In some instances rhinoplasty is not a covered benefit of the patient's policy. You cannot argue with that as the language is written into your insurance policy. If rhinoplasty is a covered benefit and there is medical necessary this can be appealed and, in most cases, the surgery can be approved. Speak with your ENT to determine if an appeal can be filed. Best of luck.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

William Portuese, MD · Answer

In order for medical insurance  to pay for a broken nose, there must be a medical necessity documented at the time of examination and consultation. It is best to refer to your booklet that was given to you from your  Medical insurance company which  has inclusions and exclusions.To repair a broken nose requires osteotomies placed in the nasal bones and re-setting them straight. Sometimes a cartilaginous spreader graft is placed underneath a concave and fractured upper lateral cartilage creating an airflow issue.  Straightening a crooked nose can be difficult, so choose your surgeon very wisely based on experience. For many examples and more information, please see the link below

Vasdev Rai, MD · Answer

There is no answer to your question.  Insurance contract is between you and your insurance. Physicians have no say.  You may appeal their decision with their appeal process. Only insurance decides as to what is covered service.Whatever is not covered becomes patient's personal responsibility.

Why will insurance not pay for a broken nose when I need eyeglasses which will not fit on my broken (very broken) nose?

Answers (4)

Answer: Insurance is a contract between you and insurance.

Answer: Insurance is a contract between you and insurance.

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Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.

Why will insurance not pay for a broken nose when I need eyeglasses which will not fit on my broken (very broken) nose?

Answers (4)

Answer: Insurance is a contract between you and insurance.

Answer: Insurance is a contract between you and insurance.

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Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.