Insurance Coverage for Fixing Broken Nose?

Insurance generally covers procedures that are to improve function and your health, but not those that are just for aesthetic purposes. It sounds like yours is for aesthetic purposes, therefore chances are insurance won't cover it (although a portion of it may be covered).To fix your nose, scars are generally placed in discreet locations so you don't have to worry about having a visible scar.

Hello! Thank you for your question! Surgical procedures for aesthetic
purposes, to improve appearance, are not covered by insurance.
Typically, these as well as complications resulting from such procedures
are the responsibility of the patient. Procedures that are meant to
correct functional issues and those which cause health-related issues
should be covered by your insurance as a medical necessity, with proper
examination and documentation. Some insurance plans have exclusion
criteria for certain procedures. Also, it is an obligation of the
surgeon not to attempt to authorize purely cosmetic procedures through
insurance.  Typically insurance will not cover a broken nose for cosmetic reasons as there is no functional deficit with these fractures.Discuss your issues and
complaints with a board-certified plastic surgeon to discuss these as
well as to examine and assist you in deciding which procedure(s) will be
the best for you. A discussion of the advantages and disadvantages will
take place along with the risks and benefits. Insurance companies will
vary on coverage and is always reasonable to discuss your issues with
your surgeon and primary care. It would behoove you to get as much
information as possible and even call your insurance yourself.
Certainly, pay in advance prior to your surgical procedure and options
such as financing are available if you qualify. Hope that this helps!
Best wishes!

It is unlikely that an insurance company will pay for the surgery. Usually, insurance companies will ask for the following when someone submits a claim for a broken nose:
1. Emergency room report at the time of injury
2. CT scan which shows broken bones.
3. A report from a qualified doctor saying that the injury is causing some kind of breathing difficulty.
It is unlikely you can have insurance pay unless you have this information.

Hi,
Thank you for your question.
This is a tough situation. There are several things goin on. It seems as though this is more of a cosmetic procedure which insurance does not cover. Plastic surgery procedures have to be determined medically necessary in order for insurance companies to cover the procedures. Even then, some insurances, especially Medicare/Medicaid, do not cover them fully.
It does not seem like this is medically necessary in your case, especially since it has been over a year and a half and you can breathe just fine. Medicare also does not pre-certify, so they never guarantee procedures, even in the most necessary cases. It would be difficult to find a surgeon who would take the risk of performing the surgery and not receiving payment.
Your story is not completely hopeless, however. Many plastic surgeons offer financing such as Care Credit where you can pay montly payments. Some may even offer payment plans in their office. Depending on what exact procedure you need, this may be an affordable option for you as it would obviously be worth it to you.
Best regards,
Dr. speron

Insurance is a contract between you and an insurance company. Your Doctor has nothing to do with the process and will expect to be paid by you. Surgeons fees vary depending on the level of expertise, so you may find variation if you seek more than one consultation.

This is one are in life where it pays to pay retail. Evaluate the surgeon, and their credentials as well as the years of experience.

If you choose to submit the bill for services to a third party, that is your own choice and I suggest you contact whomever that might be with further questions. Insurance companies make money by not paying bills, and the fewer bills they pay, the more money they make.

Despite attempts to regulate insurance companies, they routinely flaunt the law and occasionally will be fined. Relatively small fines are part of their business plan, which maximizes their profit. One example is the misuse of the Ingenix data, try Googleing the words Ingenix and United Healthcare NY attorney general. You will see just one of many examples, where data was intentionally manipulated to lower reimbursement rates.