Can Insurance Cover My Deviated Septum Issues

Question

About 10 years ago I was hit in the face with a baseball ( talking trash to my sister) , my nose has always looked fine on the outside. On the inside on the right side the septum is deviated and the bottom is cracked up. I have to pick at it to keep the nose from blocking up. I am looking for an insurance company, a doctor in Chicago, and the best way to handle this. I dont want to go and get insurance and then have them say its a pre existing condition. I appreciate your professional opinion.

Kris M. Reddy, MD, FACS · Answer

Deviated Septum causing breathing issues is usually covered by insurance. Ensurance that you have proper documentation including supporting documentation from other physicians in addition to your surgeon. It also is generally helpful to utilize a surgeon within your network.

Robert Kotler, MD, FACS · Answer

Hello &ldquo; I LoveDoctors&rdquo; in Palatine, Illinois:

	It is good to hear from Illinois, my birthplace. 

	It sounds like the injury you sustained when you were talking badly to your sister may have been the factor in your septum no longer being a midline structure and since causing you problems. 

	It is important to breathe normally, and you are entitled to breathe normally, and so the operation seems appropriate.  And the operation is a successful operation, I might add. 

	About insurance: I would advise you to speak with a broker who sells insurance from various companies; I am sure you will be able to find someone in Palatine. 

	The broker knows various insurance companies, knows the different policies and will want to get you the best policy possible. 

	Whether or not the injury to your face 10 years ago would be considered &ldquo;pre-existing&rdquo; is a question that should be answered by the agent on behalf of the insurance company that may issue the policy.  So I would start there. 

	Once you know the rules of the insurance world, then you can seek opinion with a specialist in nasal reconstructive surgery.  Therefore, my best advice is to check into insurance first, find out what may or may not be covered, then seek medical opinions, and you will be well informed.

	Our office will be glad to give you the names of several nasal surgeons with whom we are familiar in the northwest Chicago area Any would be pleased to serve you; just contact us through our website, and we can make appropriate referrals. 

	Best wishes.

	Robert Kotler, MD, FACS
	Facial Plastic Surgeon
	Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON
	Author, THE ESSENTIAL COSMETIC SURGERY COMPANION

Babak Larian, MD · Answer

A deviated septum is usually covered by insurence, but you should check with your provider.  Your surgeon's office should also be able to help determine what your insurence will cover.

Michael L. Schwartz, MD · Answer

Septoplasty for breathing problems is usually a covered procdeure under most insurance plans. Whether or not this would be a pre existing problem and not covered for you is something between you and the company you choose and not influenced by the doctor. The Obama healthcare plan is supposed to eliminate this issue but it's unknown if it will survive as currently written. 

	You do have the option of taking care of this on your own and not trying to get some company to pay for it. Just as patients pay for rhinoplasty you could get a quote as a self pay patient. This is an outpatient procedure and you may be surprised how affordable it might be on a global cash basis.

Joseph Campanelli, MD · Answer

Septoplasty is a covered service under most insurance plans. There may be some issues in regards to pre-existing conditions if you go out and purchase your own policy for the purpose of coverage specifically for this surgery. I am not an expert on insurance but I would assume that this way of 'gaming the system' is likely prohibited.

Michael Elam, MD (retired) · Answer

Having a deviated septum causes a blockage of the airway which is a condition that is typically covered by most insurance companies. All insurance companies vary in their pre existing condition policies. Some insurance companies do not have pre existing restraints and others have policies where you must have the insurance in tact for a certain amount of months prior to a scheduled procedure or diagnosis. I hope this is of some help to you. Best regards!

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