Is a revision rhinoplasty covered by insurance?

Question

I broke my nose and had a nose surgery to straighten it ou and remove the bump. However, my nose is still crooked and the bump is clearly visible. I am also having trouble breathing. Will insurance cover my next surgery?

Eric M. Joseph, MD · Answer

Most of the Rhinoplasty surgeries I perform have a functional and a cosmetic component. When eligible, your Insurance may cover your anesthesia / facility fee, along with the surgeon's fee to improve your breathing. You'll likely have a cosmetic fee as well.
You should make sure your surgeon is board-certified, and experienced in the art of Revision Rhinoplasty surgery before proceeding.
I hope this helps, and best regards.

Otto Joseph Placik, MD · Answer

The best way to know if your insurance will consider paying for the rhinoplasty is to see a qualified specialist in consultation and have him/her submit a letter of predetermination of benefits coverage for the condition.

Robert Kotler, MD, FACS · Answer

Generally, insurance is responsible for paying for surgery that corrects injury, whether a broken arm or a broken nose. This includes paying for the improvement in breathing.
Remember that cosmetic procedures are generally not covered but  a broken nose that is still deformed and cannot breathe is considered reconstructive and not cosmetic surgery.
However, you must be very attentive to your policy and confirm that benefits are available to you. The best way is to have the surgeon whom you choose submit a " Preauthorization Request " to the insurance company . Once the company issues the authorization and authorization number, it is likely -- but never certain -- that the claim will be honored.
Check with the insurance department at your employer or if you have an individual policy, check with the agent who services your policy. Leave no stone unturned because, as President Obama has said, insurance companies often let us down.

Steven Wallach, MD · Answer

Rhinoplasty revision is sometimes covered by insurance after trauma.  Each insurance company is different so you'll have to check.  If it is not a functional problem they may not cover it.

Jay M. Pensler, MD - Account Suspended · Answer

No, your insurance does not cover and should not cover the cost of revisional rhinoplasty surgery. This is a pure and simple case of cosmetic surgery.

Richard W. Fleming, MD (retired) · Answer

I strongly feel the insurance company should pay to repair a broken nose with breathing obstruction. Admittedly, Iam biased. You can request a pre-operative authorization. This will not tell you how much the insurance will pay, but at least you will know if the surgery is covered.

Theodore Katz, MD, FACS (retired) · Answer

In my experience the insurance carrier will reject a request for a revision rhinoplasty and your surgeon should submit an appeal directed to a specialist in that field (ENT or Plastic Surgery). Oftentimes patients and doctors settle for the rejection and these can be overturned on an appeal and the insurance companies count on a number of them not being appealed. Certainly, the reason still has to be the persistent obstruction of breathing and not cosmetic and this needs to be emphasized in the appeal.

Is a revision rhinoplasty covered by insurance?

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