What kinda insurance will cover septoplasty? (photos)

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

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.

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.