What kinda insurance will cover septoplasty? (photos)

this is my second post thank you to all who replied, im wondering if my insurance will cover and what my next step is, i have united health care AHCCCS, and also have about $2000 saved up really want to get this fixed, i contacted my insurance and they told me i need doctor recomendation and even then its not a forsure thing. i kno they dont cover cosmetics, but this does give me breathing problems as well as frequint sinus infections. whats my next move

Doctor Answers 5

Insurance coverage for nasal surgery

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Thank you very much for your question.

I recommend you seek evaluation by an ENT/Facial Plastic surgeon who accepts your insurance. They can properly examine and document the issues that you're experiencing, including the functional and traumatic defects on the inside and outside of the nose, the narrowing or collapse of nasal passages, deviations in the septum, and evidence of prior trauma. They would then submit that information and proposed surgery to your insurance for approval. You would be responsible for whatever portion of surgical costs that your insurance plan dictates. 

If you wish any additional cosmetic work done (something that will have no effect on your breathing, or something that is not meant to repair prior trauma), these additional costs would be discussed with your surgeon separately. Many places also offer payment plans or financing, such as Care Credit, to help with the process.

Best of luck!

Cleveland Facial Plastic Surgeon

medical insurance coverage for a septoplasty

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It's best to make an appointment with a double board certified ENT/facial plastic surgeon who accepts your medical insurance. Medical necessity must be documented at the time of the examination and consultation and then pre-authorization will be performed by that office with your medical insurance. Copays and deductibles will still apply

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Almost 100% of medical insurance plans will cover septoplasty surgery.

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Hello, thank you for your question. Insurance companies cover procedures when there is a functional impairment that needs to be corrected. In other words, if your deviated nasal septum is causing nasal obstruction (blocked breathing), your nose is not functioning properly. Proper nasal function is necessary because if your breathing is obstructed, other problems may occur such as frequent sinus infections or sleep apnea or bloody noses etc. The issue we come across that becomes frustrating is trying to get an insurance company to pay for a rhinoplasty. Many insurance plans automatically exclude rhinoplasty from the policy. Even if your nose, externally, is twisted and is contributing to the nasal obstruction, they may not even cover that surgery. Trying to get a medical insurance company to pay for a rhinoplasty requires photographs clearly showing the nasal deformity. In addition, a letter must accompany the photos describing the reason needed for the rhinoplasty. Even then, they may not approve the procedure.  One more thing, rhinoplasty surgery can be a very challenging surgery to result in a great outcome. Some rhinoplasties can take 2-3 hours. The reimbursement from these insurance companies has bend dropping precipitously over the last few years. Unfortunately, it may not be a wise business decision for a physician to take on these time consuming, challenging cases for a reimbursement that doesn't even pay the practices overhead. This is another ploy from the insurance companies to discourage surgeons from seeking these cases. The good news is, most cases of nasal obstruction can be corrected with septoplasty alone. Many times now, if a patient desires changes to their nasal appearance, they are paying for this out of pocket. Nonetheless, we treat each patient individually and on a case by case basis. By viewing your photo, your septum is pushed into your right nasal cavity quite severely and your medical insurance is very likely to cover your surgery.  Your next move is to find an otolaryngologist (ENT) doctor in your plan and have a consultation. You may want to see more than one for opinions.  I hope that answers your question. If you have an additional questions, feel free to email me at rymitchell@mac.com. 

Best regards,

Dr. Mitchell

Ryan Mitchell, DO, FAOCO
Henderson Facial Plastic Surgeon
4.6 out of 5 stars 23 reviews

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Next step for insurance septoplasty

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Hi. You should get an evaluation by an ENT/Facial Plastic surgeon. They can do an evaluation of your septum and see if you have already tried conservative measures. Once you both decide that septoplasty is right for you, then the doctor will get authorization from your insurance.

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Insurance Coverage of Surgical Procedures

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The medical insurance industry has changed drastically in the years following the passage of the "affordable care act" aka "obamacare." Due to problems with the design of the act that were obvious to medical professions before it was passed but completely ignored by politicians, the act has created an environment that is financially unsustainable. Insurance companies have now found themselves in a position where they are unable to maintain the large profits their wealthy shareholders demand while complying with the coverage requirements of the new law. Their solution to this problem has been to drastically reduce the amount of money they are willing to pay for care and as a result, they have drastically increased the amount of money patients must pay. All of that being said, medically necessary surgical procedures are still "covered" when sufficient proof is provided by your physician. However, the patient share of what is ultimately paid because of high deductibles and large co-pays is higher than ever and is likely to continue to rise. Finally, it is important to keep in mind, despite what insurance companies and others might tell you, in healthcare as in life, high quality is never low cost. 

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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.