Insurance may cover septoplasty
As Dr. Papel has noted, it is quite possible for your insurance to cover the septoplasty portion of the procedure. You should ask your surgeon to clearly deliniate the start and stop time of the septoplasty in their records, as well as showing both the septoplasty and rhinoplasty charges on your bill. I recommend that you have a physician other than your rhinoplasty surgeon document the fact that you have breathing problem attributable to a deviated septum. Then, ask your insurance company for "pre-authorization" to have the septoplasty. In this way, you will have covered all the bases and optimized your chance of having the septoplasty portion of your procedure reimbursed.
Septoplasty and Rhinoplasty Insurance Coverage
Septoplasty gets covered by insurance. Rhinoplasty does not. When you get approval, get approval for only Septoplasty codes 30520.
For the time your surgeon uses to do rhinoplasty part, lets say one hour you will pay the facility (surgery center) a pre negotiated rate anywhere from $500 to $2000 depending on the time it takes your surgeon to do the rhinoplasty part.
Same way with Anesthesiologist's fees. You pay for the time a pre negotiated fee. Most surgery centers have that rate sheet available for doctors.
Remember, when you are getting approval for septoplast you do not have to mention anything about rhinoplasty or it will confuse the insurance people and they might think you are trying to scam them.
Some Rhinoplasty surgeries have both a functional and a cosmetic component.
You can have, and should have your deviated septum repaired at the time of Rhinoplasty surgery. Most Rhinoplasties I perform have both a functional and cosmetic component. And most insurance plans will cover the functional portion of your surgery and the associated anesthesia / facility fee.
Your mom is right. If your doctor tries to get pre-authorization for a Rhinoplasty (not a covered benefit), they may subsequently deny a Septoplasty.
Your experienced, certified Rhinoplasty surgeon would be familliar with the proper protocol for getting the functional portion of your surgery covered.
I hope this helps, and best regards.
Insurance and Nose Surgery
Patients often ask if nose surgery is ever covered by surgery. 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.
Insurance generally covers procedures that are to improve function and your health, but not those that are just for aesthetic purposes. Your septoplasty may be covered but the rhinoplasty. You should ask your provider directly, however.
Septoplasty and Rhinoplasty - Insurance coverage ?
A rhinoplasty (cosmetic) can be done without a septoplasty - the operations are unique and exclusive - we typically bill insurance for the septoplasty and patient pays out of pocket for rhinoplasty. This system works fine and we have not had any issues.
Will insurance cover both septoplasty and rhinoplasty?
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. The septoplasty portion is typically covered, however not the rhinoplasty. The facility and anesthesia times should commence once the septoplasy ends.
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!
It’s Not Unreasonable To Seek Prior Authorization From Insurance For Rhinoplasty & Septoplasty
not unreasonable to seek prior authorization from insurance carriers for both
rhinoplasty and septoplasty simultaneously. Post traumatic deformities of the
nose and deviated nasal septum’s can both be caused by trauma and both problems
may therefore be covered by insurance.
not unusual for septoplasty to be covered by insurance, especially when nasal
airway obstruction is present. Under these circumstances this represents a
functional problem. Rarely insurance covers reconstructive rhinoplasty as a
some cases, insurance carriers approve septoplasty, while denying benefits for
rhinoplasty. In this situation, nothing is lost by running the rhinoplasty
through insurance. For this reason, there’s no reason not to seek prior
authorization for both procedures, if there’s any question about insurance
Insurance covers only what is medically necessary.
Cosmetic and reconstructive surgeries can be performed simultaneously without any problem. The insurance company covers any medically necessary procedures done on the internal portion of the nose such as a septoplasty for breathing. Any elective cosmetic procedures can be done at the same time without any need to worry about insurance coverage issue. The patient is responsible for the cosmetic portion of the nose.
Insurance Coverage for Septoplasty and Rhinoplasty
Septoplasty may be covered by your health insurance if significant functional issues are caused by the septal deviation. An aesthetic rhinoplasty will not be covered.
In general, it is important for you to be forthcoming with your surgeon and your surgeon to be honest with you and the insurance company about your condition and physical findings. For instance, doing a septoplasty in order to receive insurance coverage in the absence of good medical reasons is certainly not in the patient's best interest ...