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Will insurance pay for revision rhinoplasty if the primary rhinoplasty caused breathing problems?

I had septorhinoplasty to fix a breathing issue. I can't breathe through both nostrils now and before I could breathe great out of one side. I really believe the dr pinched the bones against the septum. There is also a cartilage graft sticking way up and the crookedness has not changed one bit. Is there a dr in New England that can help me and is there any way insurance would help?

Doctor Answers 4

May 18th, 2014

Will insurance pay for revision rhinoplasty if the primary rhinoplasty caused breathing problems?

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    If an anatomic obstruction can be identified, then insurance will usually cover the functional aspects of the surgery.

Kenneth Hughes, MD

Los Angeles, CA

Learn more: http://www.hughesplasticsurgery.com/Rhinoplasty.php

Kenneth B. Hughes, MD


Los Angeles Plastic Surgeon
4.9 out of 5 stars 517 reviews

May 11th, 2014

Insurance coverage for nasal obstruction after rhinoplasty

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The answer to your question relies on accurate diagnosis and documentation of your functional impairment.  If an examination reveals that you have a structural abnormality that impairs breathing regardless of the causality, it is likely that a portion of the procedure would be covered by insurance. It has to do with accurate coding.  Typically this entails nasal valve repair with cartilage grafting and nasal septum procedures.  Fracturing of the bones of the nose is rarely necessary to improve breathing - the rhinoplasty component to make you nose look better may not be covered and could be a separate add on procedure with your physician and hospital and anesthesia costs. A functional rhinoplasty ie for breathing difficulties is a hard sell, unless there is strong argument for the need to fracture the nose. This can require your physician to be involved in a peer to peer review by the insurance expert representative, usually another plastic surgeon to prevent fraud and abuse. I hope that answers your question. 

Arthur N. Falk, MD
Albany Facial Plastic Surgeon

May 11th, 2014

Insurance coverage for functional rhinoplasty

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Even though I am not in New England, I will try to answer your questions. There is always a gray line between functional and aesthetic rhinoplasty. Listening to your concerns, you have problems breathing thought the nose along with complaints of nasal asymmetry and deviation. The way I see it, you have a combination of functional and aesthetic problems. Insurance commonly covers functional surgery, but you have to understand that a strict functional procedure may not address and correct your aesthetic problems. You may be able to find a surgeon who would adress both without charging you extra for cosmetic component. But make sure that you are not sacrificing quality while trying to cut down the cost. 
Alexander Ovchinsky, MD

Alexander Ovchinsky, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 32 reviews

May 11th, 2014

Possible

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Sorry to hear about your ordeal. If the initial operation was for medically necessary symptoms, any subsequent revision will most likely be covered by insurance company. The best option is to have a consultation with a board certified plastic surgeon to discuss your concerns. At that point, your plastic surgeon can guide you appropriately and get your next surgery pre-certified with your insurance company. Best of luck!
Dhaval M. Patel, MD

Dhaval M. Patel, MD
Hoffman Estates Plastic Surgeon
4.8 out of 5 stars 98 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.