How much does insurance cover for septorhinoplasty?

Question

I have had 2 quotes for a functional septorhinoplasty. My insurance company says they will cover the breathing part, but how much can I expect? I had one Dr. quote $4100 and one for $7000, plus the operating room. Insurance wont tell me upfront until after the surgery!

Manish H. Shah, MD, FACS · Answer

Hello,Thanks for your question. When you are having a combination cosmetic and functional rhinoplasty surgery, the time to do each portion of the case is recorded. Your insurance company will only pay for the time used to perform the functional component. The costs you've described are to cover the cosmetic portion of the case. You will save a little on a portion of the anesthesia and facility costs. Your surgeon will charge your insurance company separately for their performance of the functional component. Most people think that they save money this way, but they typically pay more and the surgeon makes more money. In my practice, when I perform a combination cosmetic and functional rhinoplasty (80% of my caseload) I don't charge anyone for the functional rhinoplasty. I just charge to perform the cosmetic portion. It makes no sense to get a pretty nose that doesn't function well! If you'd like to discuss this further, please give my office a call.Good luck,Dr. Shah

P. Daniel Ward, MD · Answer

Rhinoplasty can be performed for both cosmetic and functional (medically-indicated) reasons. Insurance companies will not pay for the cosmetic portions, but will pay for the functional issues. The costs associated with these procedures, especially when performed together can be difficult to understand. For the cosmetic portion of the surgery, there are three main costs, the surgeon's fee, the anesthesia fee, and the facility fee. The sum of these fees is usually in the range of $5000-$9000. This amount should be readily available at your surgeon's office. We give all of our patients a quote the day of the consultation so they know the exact cost for the cosmetic portion up front. I know this will be surprising, but, believe it or not, the functional part of the surgery, i.e., the part of the surgery that involves the insurance company, is much more complicated! : ) The details of the exact functional cost depends entirely on your insurance plan. The important details to consider are the amount of your co-pay, your co-insurance, and your deductible. These vary greatly from plan to plan. To determine the details of these issues, be sure to consult your individual insurance plan website or booklet. Most surgeon's offices are happy to provide advice as to how to help navigate this process.I hope this helps. Please let us know if you have any questions or concerns!

William Portuese, MD · Answer

This is a very complicated question to be able to answer, since there are so many variables. Medical insurance will only pay for a functional problem such as breathing which might include a septoplasty, turbinate surgery, and a spreader graft for significant valve collapse. Medical necessity must be documented along with pre-authorization prior to the surgery.  There are hundreds of different medical healthcare insurance plans, and each of them have different amounts of co-pays and deductibles. You will be responsible for the co-pays and deductibles which  usually can be estimated by the physician's office  ahead of time. It is only an estimate. It's important to check your specific health plan insurance booklet for all the details regarding that. A rhinoplasty is considered cosmetic, and must be paid for by the patient since there's no medical necessity. A financial quote for that component is also given out  to the patient at the time of the consultation so that you know how much the cosmetic component is going to be. Most practices require cosmetic surgery to be paid for up front in advance. Look for a surgeon's office who performs both functional nasal  surgery and cosmetic surgery in combination, since they will be dealing with this issue frequently. Both  cosmetic and functional procedures can be performed together, however there will be anesthesia fees, operating room fees, and surgeon's fees  billed separately for both the functional and cosmetic  components.  Cosmetic rhinoplasty is much more complicated than the functional surgery, so choose your surgeon very wisely based on extensive experience, not based up upon price. For more information about the differences between a septoplasty and a rhinoplasty, please see the video below

How much does insurance cover for septorhinoplasty?

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How much does insurance cover for septorhinoplasty?

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