Will I be able to get septorhinoplasty covered by my insurance?

Question

I feel like my deviated septum Is due to nasal bone deviation in the dorsal area.My nose really bothers me. I know I have a deviated septum. I can't breath through my right nostril at all. But nose looks Crooked because of the nasal bone its self. From the dorsum area there is a bump and it extends outward. And I feel like as I get older it gets worse. Could it be possible that my breathing problem is caused by my deviated nasal bone?

William Portuese, MD · Answer

A septoplasty is performed for obstruction of breathing out of the nose due to blockage of bone and cartilage in the back of the nose creating air flow issues. A septoplasty is performed only to improve air flow through the nose, and will not change the shape of the nose. After an internal examination of the nose, a deviated septum must be present to document medical necessity for insurance purposes. Straightening a crooked nose is performed with a rhinoplasty which is completely separate than a septoplasty.  Cosmetic straightening of the nose is accomplished with osteotomies placed in the nasal bones, and sometimes a spreader graft placed underneath a concave upper lateral cartilage in the midportion of the nose. Patients must pay for the rhinoplasty component, since it is cosmetic.  Both a septoplasty and a rhinoplasty procedure can be performed together under one anesthetic with one recovery period. For more information and diagrams describing the differences between the 2 procedures, please see the video and the link below

Jeffrey Weinzweig, MD, FACS · Answer

Patients often ask if nose surgery is ever covered by insurance. The answer is – it depends on the reason and type of nose surgery required. Rhinoplasty surgery is focused on improving the outward appearance of the nose and is solely a cosmetic surgical procedure. Septoplasty surgery is focused on correcting airway related nasal issues and is many times a procedure that can be covered by health insurance. Frequently, rhinoplasty and septoplasty procedures are combined into one surgery so that both goals – one cosmetic and the other medical- can be achieved in one surgery.

Anand G. Shah, MD · Answer

Please note that every insurance company has different policies.  Generally speaking, septoplasty (reshaping of the septum, or wall, between the nostrils) is considered a functional, medical procedure and covered by insurance.  Rhinoplasty (cosmetic external nose reshaping) is considered cosmetic and generally not covered by an insurance policy.If you like, please follow the link below.  The article on Nasal Analysis contains many diagrams that you may find helpful.  This may help guide your conversation with your surgeon.Hope this is helpful.  Best wishes.

Sanaz Harirchian, MD · Answer

Hi i2000. Thanks for your question. Most insurance companies cover medically necessary portions of surgery. Frequently, noses that are crooked don't breathe well. Therefore, I frequently perform septorhinoplasties to improve both the breathing and appearance at the same time. Good luck. Best, Dr H

Richard W. Fleming, MD (retired) · Answer

Every insurance policy is different but most will contribute to the cost of correcting functional problems such as breathing obstruction. My staff always assists our patients when they try to evaluate their insurance coverage.

Will I be able to get septorhinoplasty covered by my insurance?

Answers (5)

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