Could any of my nose reshaping be covered by UHC Choice PPO insurance w/medically necessary septoplasty & sinoplasty?(photo)

Currently in +3rd month of severe sinus infection that is not going away with medications & this has happened before. *Summary attached, CT scans from 2011, current CT was done this month. I'm a twin mom w other surgeries needed due to major weight loss so cost & some shaping is very important. Are there any surgeons nearby (Frisco, TX) that are in-network AND has experience getting approval for all 3 procedures in one? (dorsum/tip) OOP & Deductible met

Doctor Answers 6

Insurance often helps ...

... but really, it tends not to help a lot if there are cosmetic changes to make. But every little bit, right?

See the "Web reference" link, just below my response. I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands.

I elevated the tip , and lowered the bump on the bridge of your nose. The airways can be addressed at the same time as the cosmetic concerns.

You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle. Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon.

Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he'll change, and by how much he'll change them -- so you know whether it's enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. Then, he must show you before and after photos to prove that he can actually accomplish what he draws on the computer.


Omaha Facial Plastic Surgeon
4.8 out of 5 stars 37 reviews

Insurance coverage for septoplasty and sinus surgery

Insurance coverage is commonly performed for medically necessary procedures such as septoplasty and sinus surgery. A cosmetic rhinoplasty would be billed separately. You may elect to have the sinus surgery separate due to the need for nasal splinting. 

Jose E. Barrera, MD, FACS
San Antonio Facial Plastic Surgeon
5.0 out of 5 stars 40 reviews

Yes

it is entirely common and practical to address both the functional and cosmetic needs of your nose. Depending on your insurance plan, usually the septoplasty and sinus issues can be addressed via your insurance. Make sure you find a surgeon with experience in addressing both the functional and cosmetic needs of the nose.

Sandy Sule, MD
Dallas Facial Plastic Surgeon
4.3 out of 5 stars 12 reviews

Septoplasty and Insurance

If the septum is moderately to severely deviated and you are symptomatic, the chances are good that your operation will be covered by insurance.  Check with your online benefits or call your company to see.

Jay Calvert, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 47 reviews

Functional septoplasty, functional endoscopic sinus surgery, and cosmetic rhinoplasty

 A septoplasty is performed for functional purposes to improve air flow through the nose, once medical necessity has been documented at the time of examination and consultation. In addition,  Functional endoscopic sinus surgery is also performed for polyp removal to help with chronic sinusitis infections and open up the sinuses. Both of these procedures are billed  to the patient's medical insurance, once medical necessity has been met and documented. Co-pays and deductibles will still apply.
 A cosmetic rhinoplasty can be performed at the same time as the functional surgery, but must be paid for by the patient themselves, since this is a completely separate elective procedure. A cosmetic rhinoplasty can accomplish straightening the nose, refining  the tip, shaving down the dorsal hump and narrowing the bridge line. For more information  about all 3 types of surgeries,and many examples  of rhinoplasty, please see link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

Cosmetic and Functional surgery

Rita,

It is common to address both cosmetic and functional sinus/nasal issues at the time of the same surgery.  Many times it is at least partially covered by insurance plans but that obviously depends on each individual patient's needs and their insurance plan.  I would recommend you see a Facial Plastic surgeon that is double board certified in Facial Plastic & Reconstructive Surgery as well as Otolaryngology to discuss this further.

Colin Pero, MD
Dallas Facial Plastic Surgeon
4.6 out of 5 stars 13 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.