Can medical insurance partly cover rhinoplasty if the surgery is performed for both breathing and cosmetic reasons?

Question

I have a deviated septum that almost entirely reduces airflow through one nostril—to the point where I cannot comfortably breathe through it if the other nostril is blocked. I also have a bulbous tip, a moderate dorsal hump, and nostril asymmetry when viewed from the front. If I were to have surgery for to address all of these issues, would insurance cover the cost of septoplasty? I currently live in Montreal and am only covered by Quebec provincial insurance (RAMQ).

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  Depending on your insurance provider, a septoplasty can usually be completely covered by insurance in this setting.  Rhinoplasty can be performed at the same time (usually about half of the regular price).  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Harry V. Wright, MD · Answer

In the States this is common. I performed 2 such surgeries this week. It is especially important to find a surgeon who is competent to achieve your goals, both functional and cosmetic. Best wishes!  Harry V. Wright MD, Sarasota, Florida

Satyen Undavia, MD · Answer

Thanks for your question. Yes as long as your surgeon properly documents your complains they will cover the septoplasty portion of your surgery, you would just be responsible for the cosmetic portion of the procedure. Good luck!

Richard W. Fleming, MD (retired) · Answer

In the United States most insurance plans will contribute to the cost of functional improvement in nasal surgery. An experienced rhinoplasty surgeon can help you determine the benefits of your particular insurance plan.

Randolph Capone, MD, FACS (in memoriam) · Answer

If you suffer from chronic nasal airway obstruction (stuffiness) that is resistant to medications that help open the nasal airway, AND you've seen a doctor that has documented a deviated septum, inferior turbinate hypertrophy, nasal valve stenosis/collapse, or nasal fracture with deformity, then you should be able to get your INSURANCE to cover that portion of the surgery that is airway related. This is the medically necessary portion of the surgery. The remainder of the rhinoplasty is considered cosmetic in nature since it changes the external appearance of your nose in a desirable way. Cosmetic work is self pay. So, in essence, you can roughly think of your insurance paying for the "inside work" and the "outside work" is your responsibility. This benefits many patients by helping them achieve their goals of having a great looking nose with improved breathing.  -Randolph Capone, MD, FACS

Can medical insurance partly cover rhinoplasty if the surgery is performed for both breathing and cosmetic reasons?

Answers (5)