Will BlueCross PPO or Aetna cover my Rhinoplasty?

Question

I'm looking into a open rhinoplasty but has extreme issues breathing through my nostrils as well as a runny nose for a few years now. I don't know where to start or what questions to ask reguarding insurance. I currently have BlueCross of Illinois traditional PPO through my father and Aetna through my husband.

Parker A. Velargo, MD, FACS · Answer

If you are receiving a septoplasty, some insurance plans cover that aspect of the procedure. Contact your insurance carrier for information. Note that cosmetic rhinoplasty is never covered by insurance plans, and even if your insurance covers a simultaneous septoplasty, a separate charge will be generated for the cosmetic component of your surgical plan.The first step is to have an in-person examination by a facial plastic surgeon or plastic surgeon so that the septum and nasal valves can be evaluated.   I wish you well!

Ronald J. Edelson, MD · Answer

If you have a breathing issue, part of the rhinoplasty may be covered under insurance, but in all likelihood, it will cover only a small portion.

Michael I. Echavez, MD · Answer

Medical insurance sometimes may cover any portion of rhinoplasty that is not deemed cosmetic.  You could either contact your insurance company directly to ask them about coverage or after you have a consultation with a surgeon, you could have their office contact your insurance and ask about coverage.

Kimberly Lee, MD · Answer

Patients who have severe underlying breathing problems may have an anatomic cause.  A thorough evaluation of both the inside and outside of the nose is recommended.  If there is an anatomic component, that can usually be billed to insurance; however, the cosmetic component cannot.  Please consult with a board certified specialist with a background in ENT/Head and Neck surgery who can assist you with this process.  3-D computer imaging can help you visualize what you may look like afterwards and serve as an important communication tool with your surgeon.

William Portuese, MD · Answer

There are many issues inside the nose  that can create chronic breathing problems. These include a deviated nasal septum, turbinate hypertrophy, valve collapse,  vestibular stenosis, chronic sinusitis, and allergies. Each one of these issues are treated differently with either medications or surgery. Medical management is always tried first prior to proceeding with surgical management of airway problems. Functional nasal surgery is performed for medical necessity which is documented at the time of examination and consultation. Functional nasal surgery will not change the shape of the nose, only improve breathing. Functional nasal surgery is usually billed to the patient's medical insurance, while co-pay and  deductibles will still apply. A rhinoplasty is performed for cosmetic purposes through either an open or closed approach. Since it is cosmetic, patients must pay for that component themselves. Functional nasal surgery and cosmetic rhinoplasty can be both performed at the same time, under one anesthetic with one recovery period.Medical insurance will not cover cosmetic rhinoplasty. For more information describing the differences in the 2 procedures, please see the video below

Michael Elam, MD (retired) · Answer

Dear Simonai, A septorhinoplasty is a combined procedure addressing both the cosmetic and functional aspects of the nose. The "septo" portion addresses the breathing aspects of the nose while the "rhinoplasty" portion addresses the aesthetic issues. The functional and breathing portion of the procedure may be billed to the insurance company while the cosmetic portion is not covered. After examination and consultation your surgeon will be able to determine whether you have a deviated nasal septum and/or turbinate issues that need addressing. Once you are diagnosed then the patient coordinator can get copies of your insurance cards and send a pre-certificartion letter to your insurance company which will state what percentage they will pay depending upon your policy. While these amounts vary depending on your policy it will provide you with a  good idea of possible payment amount prior to committing to surgery so that there are no surprises in the end. Best regards, Michael V. Elam, M.D.

Dennis Barek, MD (retired) · Answer

Get a predetermination of benefits from the insurance companies.They will require medical records and test results and often pictures.This way you know before hand.

David Alessi, MD - Account Suspended · Answer

Insurance typically will cover rhinoplasty for breathing problems.  If it is purely cosmetic, they will not.  Seek out a surgeon who is double boarded in ENT and  Facial Plastics.  Make sure their staff is adept at working with insurance and they will be able to discuss with you the chances of getting it covered.  Best wishes.

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