Will my insurance cover for septoplasty? (Photo)

Question

I have a deviated nose due to a punch to the face. I constantly get sinus infections, head aches and I have trouble breathing when I sleep. My insurance plan is LA Care/Bella Vista. Will my insurance will cover for the procedure?

Manish H. Shah, MD, FACS · Answer

Hello miriam_m,Thanks for your question.I would recommend that you contact your insurance company to see if your policy has a rider that shows that they do not cover septoplasty surgery.If your insurance does allow for septoplasty, then a surgeon in your area can perform an exam that confirms a septal deviation that would require surgery to fix.  Your insurance will require that you trial non-surgical treatments like nasal saline, humidifiers, nasal steroids, anti-histamines, etc. and fail these treatments before they OK surgery.  This is very typical.Good luck,Dr. Shah

Jay Calvert, MD, FACS · Answer

In general, insurance will pay for deviated septum surgery when the septum is moderately or severely deviated AND the patient is symptomatic.  Different insurances have different rules about how much medical therapy is necessary before saying that the medical therapy has failed.  This is also an important criteria as to whether or not your insurance will pay.

Mohsen Tavoussi, MD, DO · Answer

Your insurance should cover correction of traumatic injuries as well as sinus surgery if you have one. You may have to go to a surgeon who accepts and listed with your insurance.

William Portuese, MD · Answer

A  septoplasty is performed for medical necessity to improve functional nasal breathing, and will not change the shape of the nose. A septoplasty is performed in the back of the nose when there is twisted bone and cartilage blocking air flow.  A rhinoplasty is performed for cosmetic purposes to change the shape of the nose such as straightening it, narrowing the tip, narrowing the bridge and shaving down the dorsal hump.   Chronic sinus infections must be documented with a CAT scan of the paranasal sinuses, once medical treatments have failed. Endoscopic sinus surgery is performed and patient's polyps inside the sinuses causing chronic sinus issues. For more information on all the above procedures, please see the link below

Arian Mowlavi, MD, FACS (license on probation) · Answer

Insurance coverage can be obtained for correction of a broken nose and crooked nasal deformity. Insurance company will require history of having tried over six months of nasal spray as well as photograph confirming your crooked nose.

Richard Ellenbogen, MD (retired) · Answer

With the proper documentation of functional improvement they should but in many cases they refuse. They are not stupid they realize in my estimation 50% of all septoplasties by ent surgeons are bogus and basically a cover for a cosmetic rhinoplasty

Michael Elam, MD (retired) · Answer

Dear Miriam_m, After an examination and diagnosis is made of deviated septum then a pre-authorization can be sent to your insurance company and they will send over an explanation of benefits which will describe your insurance coverage. Once this is received the surgeon can review the costs with you and explain your insurance coverage. Most insurance policies do cover functional issues with the nose. My patient coordinator can check possible benefits by receiving a copy of the patients insurance information prior to consultation and then after consultation and an intra-nasal examination depending on the diagnosis a pre-certification letter can be sent to the insurance company for approval. Best regards, Michael V. Elam, M.D.

Will my insurance cover for septoplasty? (Photo)

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