Can My Insurance Pay for Bump Removal on My Nose During Surgery for My Deviated Septum?

Question

The doctor told me that i need surgery because of some chronic inflamation in my nose and a deviated septum. Because of that I snore and can't sleep very well but along with that surgery I would like to eliminate a little bump on my nose. Not big deal. Can my insurance pay for all together?

Paul S. Nassif, MD · Answer

Depending on your insurance company, they will typically cover some or all of the functional portion of your procedure. Occasionally, if a structural abnormality contributes to impaired breathing, insurance may cover the part of surgery which fixes this issue. This is usually the case when a patient has nostrils that are pinched, or a crooked nose. A hump does not impair breathing, so it is not likely that rasping of a nasal hump will be covered by insurance. This is a cosmetic procedure that would be billed separately. Thanks, and I hope this helps answer your question.

Philip Solomon, MD, FRCS · Answer

In Ontario, Canada our government insurance provider called OHIP will pay for functional nasal surgery.. Examples include septoplasty and in some cases septorhinoplasty for breathing. Removal of a bump is considered cosmetic surgery and not an insured service. In some situations if a patient requires septoplasty and bump removal a portion of the procedure would be covered and the cost for the cosmetic procedure may be slightly less than if done for purely cosmetic purposes.

Stephen Weber MD, FACS · Answer

This is a very frequent question and I understand the motivation. However, insurance companies are well aware of patients trying to have cosmetic portions of a procedure covered by their insurance policy. If insurance companies discover this has occurred they can refuse to cover any part of the procedure which can result in a significantly larger bill for you. It is also dishonest on the part of the plastic surgeon to try to "sneak" some changes in your nose into the legitimate insurance procedure. It is not worth the risk to you or your surgeon to try to do this.Stephen Weber MD, FACS

Robert L. Kraft, MD, FACS · Answer

Insurance companies are getting sneakier all the time.  Only the portion of the operation involving functional medical necessity wil be covered. Correcting that little bump can take much longer in the OR than repairing the deviated septum. For generations, insurers paid enough for the deviated septums to cover the cosmetic work and now the pendulum has swung in the opposite direction.  The allowance for the septum is so low as to be laughable ($750 for example).  So, you would be better advised to find a board certified plastic surgeon with whom you are comfortable and to contemplate a fee for service procedure which will, when you crunch the numbers, be less expensive and more productive in terms of your goals.

Larry Fan, MD · Answer

Dear Maribell:

	 

	Every health insurance plan is different, but most will provide coverage for rhinoplasty and/or septoplasty surgery performed to relieve nasal obstruction caused by a deviated septum.

	 

	Unfortunately, changing the appearance of your nose (eg. removing a bump) is considered cosmetic in nature and therefore not covered by insurance.

	 

	Hope this helps.

	 

	Warmest wishes,

	Larry Fan, MD

Shervin Naderi, MD, FACS · Answer

First of all bump removal or any cosmetic change to the nose is not covered by insurance. Frankly today many insurances create so many obstacles for your doctor's office and resist paying for even the septoplasty. 

	As far as the bump being no big deal: I have seen hundreds of patients who have come for revision rhinoplasty who had gone for what they thought was a "simple" rhinoplasty. Be careful and do your research so that you end up with the highest chance of success.

Theodore Diktaban, MD, FACS (retired) · Answer

Dumping the hump at the same time as a correction of a deviated septum does not fly because the hump does not interfere with nasal function the majority of the time. People who have had nasal trauma that resulted in a hump deformity, most of the time it is deemed to be cosmetic even though you broke your nose. If the nose were severely traumatized by the trauma and interfering with nasal breathing, then a claim might be made to have it covered by insurance.

Michael Elam, MD (retired) · Answer

A Septoplasty is sometimes covered by your insurance company when you have  a deviated septum and breathing difficulties. This is dependent on your carrier. Some companies require preauthorization and others will give you an estimate of expected coverage. When you discuss cosmetic changes such as Septorhinoplasty which  is a combination of both the functional aspects and cosmetic aspects then this is not covered by insurance. Best regards!

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