Insurance Cover Rhinoplasty or Nose Job Surgery?

As pointed out by other surgeons, the answer to this question can get very complicated.

Your health insurance plan should cover any nose surgery (including surgeon fees, anesthesia and facility costs) that is done with the specific intention of improving your nasal breathing and/or repairing structural damage from a nose injury. Of course, obtaining pre-authorization from your insurance carrier is always recommended. This means the proposed surgical procedure and indications for the surgery are presented to your insurance carrier in advance. They review the documentation provided and respond accordingly whether or not they feel the surgery is medical indicated. If the answer is yes, they will usually provide coverage (payment) for those procedures requested.

Anything done during that surgery that is intended to reshape the nose for cosmetic reasons is not covered. This includes any supplies used and anesthesia given during that time devoted to the cosmetic portion of the surgery. Consequently, you will be responsible for paying out of pocket for the surgeon fees, anesthesia and facility costs for this portion of the case. Although you are already asleep under anesthesia for the functional surgery, the anesthesiologist is required to bill you separately for the time spent under anesthesia for the cosmetic reshaping.

Usually the total cosmetic fees (surgeon, anesthesia and facility combined) are discounted when done in combination with insurance procedures. However, you as the patient need to be mindful that you are still responsible for any and all deductibles and copays triggered by your health plan. Some patients have a low deductible while others have a high deductible. This can significantly impact how much you end up paying in total for both the functional surgery and the cosmetic reshaping. Make sure to read your individual policy very carefully and ensure that you understand the terms of your policy in detail. This can be the source of much disappointment in some cases.

It’s not unreasonable to seek prior authorization from insurance carriers for rhinoplasty and septoplasty when these deformities are associated with trauma.  In addition, deviated nasal septums are often associated with nasal airway obstruction.  Under these circumstances insurance carriers will often cover the expense associated with this procedure because of its functional significance.

            Unfortunately, if nasal deformities aren’t associated with trauma, they’re unlikely to be covered by insurance carriers.  Under these circumstances, the expense of rhinoplasty, including anesthesia, would be the patients responsibility for this portion of the procedure.

            If you have questions regarding this issue, it’s important to discuss them with your surgeon.  Your surgeon should be able to answer your question and clarify this issue.

Insurance questions are best addressed by your insurance policy provider. Pure Cosmetic Surgery is not usually medically necessary nor a covered expense. It's best to review your insurance policy and see what's covered. Prices vary from Practice ti Practice, experience of a Surgeon, etc.