Under what circumstances would septorhinoplasty be covered by insurance? (photos)

My deviated septum is caused by a deviation in the structure of my nose. I am prone to sinus infections an and have trouble breathing. I also have sensitive asthma and allergies which seem to exacerbate the difficulty breathing. I get frequent nose bleeds(on one side), severe congestion, and sinus headaches as a result. Would these symptoms, in your experience, result in insurance coverage? Would I need to see an ENT doctor to refer me to a surgeon? How does this work? Should I visit an ENT before or seek surgeon directly? Thanks!

Doctor Answers 13

Septoplasty vs. rhinopalsty

Based on your symptoms you most likely will benefit from functional nasal surgery which may include septoplasty, nasal valve repair, and possibly turbinate reduction.  Rhinoplasty to improve he external appearance of the nose is a cosmetic procedure and not covered by insurance.

Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Insurance coverage for portions of septorhinoplasty

You certainly have significant functional airway obstruction fron a deviated septum, and probable nasal valve collapse. These conditions are usually covered by insurance, and additional aesthetic improvements can be performed simultaneously in a well planned procedure. There would typically be additional out of pocket expenses for the non functional rhinoplasty surgery, which should be discussed ahead of time with your rhinoplasty surgeon.

Harrison C. Putman III, MD
Peoria Facial Plastic Surgeon
4.7 out of 5 stars 13 reviews

Under what circumstances would septorhinoplasty be covered by insurance?

Hello, and sorry to hear about the issues you are experiencing. In general, insurance will cover some or all of any functional portion of your surgery. This will depend on the following:

1) The nature of the issue
2) Your insurance company

Based on your issues, insurance will help. You may or may not need to see an ENT, as this depends on your insurance policy. Some ENT surgeons will repair a deviated septum. A facial plastic surgeon who is a rhinoplasty specialist is also a great choice, and you can go to him or her directly without a referral. Make sure your prospective surgeon has great credentials and is very experienced. I hope this helps, and good luck to you.

Jonathan Kulbersh, MD
Charlotte Facial Plastic Surgeon
5.0 out of 5 stars 69 reviews

Correction of breathing problems by reconstructive rhinoseptoplasty

This is a frequent question that we deal with in plastic surgery. Septal deviation is covered by insurance more frequently than the more external rhinoplasty.  However, if the nasal bones are deviated enough to one side that they are contributing to the septal deviation then that may be covered as well.  Experienced plastic surgeons have learned what questions to ask about your symptoms, previous injury and various types of treatment that you have tried and found unsuccessful.  These are what we use to explain the indications for getting insurance pre-authorization.  In our community, some ENT physicians will do an external, cosmetic rhinoplasties and others will not.  When calling a plastic surgeon's office you should ask if they are experienced in various types of rhinoplasties. 

John M. Weeter, MD
Louisville Plastic Surgeon
5.0 out of 5 stars 7 reviews

Septal surgery

Often the breathing issues are covered by insurance. The cosmetic improvement is not. Best to be seen in person to be properly evaluated.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews


The breathing portion of the procedure (septoplasty, turbinate reduction) is usually covered by insurance. (the external rhinoplasty part of the procedure will not be covered) That determination must be done by the doctor's office through a submitted letter after the consultation. You do not need a specific referral, you can just go to any doctor that regularly performs septorhinoplasty surgery. Based on your pictures, you should get a significant functional and aesthetic improvement from septorhinoplasty surgery. 

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

Insurance Payment for Deviated Septum Correction

Most health insurance companies will cover portions of the cost of surgery to improve breathing function. This is a common question; my staff will help our patients in dealing with their insurance provider.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 39 reviews

Septoplasty and rhinoplasty are 2 separate procedures

A septoplasty  is performed for blockage of airflow in the back of the nose when There is obstructing cartilage and bone that needs to be removed. This is performed for medical necessity. A septoplasty will not change the shape of the nose.
Chronic allergies and sinus infections and headaches  can be caused bysinus polyps, which are removed with endoscopic sinus surgery. Also important that your allergies under control with testing/ allergy shots and environmental avoidance. A CAT scan of the paranasal sinuses is required to make that diagnosis.
  Nosebleeds are treated with silver nitrate cautery in the office or surgical electrocautery in the operating room, when severe enough.
A rhinoplasty is performed for cosmetic purposes to straighten the crooked nose, remove any hump and adjust the tip cartilages as necessary.
For more information about all the above and our photo gallery, please see the link below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Under what circumstances would septorhinoplasty be covered by insurance?

Septorhinoplasty to improve breathing is typically covered by insurance. This varies by carrier and plan, however. Your photos show a dramatic lack of support in your nostril which creates a severe breathing disturbance. There is a strong argument to add structure to your nose to improve your breathing and quality of life. If you're also looking to make any cosmetic changes to your nose those would not be covered by insurance but the basic changes to get you breathing better should be. I hope this information is helpful for you.

Stephen Weber MD, FACS
Denver Facial Plastic Surgeon

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 129 reviews

Under what circumstances would septorhinoplasty be covered by insurance?

Only the functional portion of the septaloplasty would be insurance covered. Any cosmetic portion is NOT covered... 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 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.