Insurance Cover Rhinoplasty or Nose Job Surgery?

I am interested in having a rhinoplasty or nose job. What cosmetically bothers me is the hump or bump I have on my nose that makes it look crooked. I also have trouble breathing and an ent i saw years back said I have a deviated septum. Would insurance cover any of the bump correction if I have surgery to correct the deviated septum? And if not, how much will be left for me to pay if I choose to do the deviated septum and rhinoplasty at the same time? I'm assuming i wouldn't have to pay for anesthesia so how much would the total doctor fee only be approx? How much was your surgery?

Doctor Answers 7

Insurance Coverage For Rhinoplasty and Septoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.

San Diego Facial Plastic Surgeon
4.7 out of 5 stars 44 reviews

Insurance Coverage for Rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The insurance coverage for surgery is dependent on your individual healthy insurance policy. For nose surgery, most insurance companies will scrutinize the procedure carefully to make sure that it is not for cosmetic reasons. Insurance may cover nose surgery for breathing problems like a deviated septum. If you decide to add a cosmetic refinement of the nose to the insurance coverage nose surgery, then you will have to incur the cost of the cosmetic portion. That includes that surgeon's fee, anesthesia, an operating facility. Each facility, anesthesia, and surgeon will have their own fee schedule.

T.Y. Steven Ip, MD, FACS
New York Plastic Surgeon

Insurance coverage for rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Most insurance companies will pay for the functional portion of your sugery. It is always a good idea to get a predetermination of benefits before embarking on an elective surgery such as a septoplasty. The bump on the nose would be considered cosmetic and insurance will not generally pay for that portion of the procedure. The costs involve will vary depending on your insurance, the location of the procedure, and the area of the country you are in. Generally you will have a facility fee, a surgeon's fee, and an anesthesiologists fee. All of these will vary. Remember though, rhinoplasty is one of the most difficult cosmetic surgeries to get just right. Visit with a qualified and experienced facial plastic or general plastic surgeon and not just the least expensive guy in town.

D.J. Verret, MD
Dallas Facial Plastic Surgeon

Does insurance pay for rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Good question.  This is a common question we get in the office.  IF insurance will pay it only pays for FUNCTIONAL issues.  That is issues that affect the function of your nose like breathing.  All aesthetic issues like humps and tips are not covered by insurance.  As for costs it varies from surgeon to surgeon and depending on the degree of cosmetic change you desire.  Best option is to go and see a surgeon in person and allow him to help you

Rady Rahban, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 141 reviews

Rhinoplasty question

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

 Insurance, on some policies covers rhinoplasty perform for functional reasons. Under this definition includes correcting a crooked nose after trauma, septoplasty, and procedures to improve breathing. If there's anything cosmetic then insurance will not cover the procedure. This portion would have to be paid out of pocket. Typically if you would like to have insurance pay for your procedure, you would have to send in a predetermination to the insurance company. The insurance company will scrutinize the claim and then give a decision. Some plans do not cover rhinoplasty. But again, you would need to document functional symptoms  and often send the documentation and pictures to the insurance company. Good luck! 

Kailash Narasimhan, MD
Saint Petersburg Plastic Surgeon
5.0 out of 5 stars 18 reviews

Insurance cover rhinoplasty or nose job surgery?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Hello! Thank you for your question! Surgical procedures for aesthetic purposes, to improve appearance, are not covered by insurance. Typically, these as well as complications resulting from such procedures are the responsibility of the patient. Procedures that are meant to correct functional issues and those which cause health-related issues should be covered by your insurance as a medical necessity, with proper examination and documentation. Some insurance plans have exclusion criteria for certain procedures. Also, it is an obligation of the surgeon not to attempt to authorize purely cosmetic procedures through insurance.  Your septoplasty portion, which is causing you a functional deficit of breathing is certainly something often covered.  However, the aesthetic changes to your nose are not.  The facility fee and anesthesia fees should begin once the insurance procedure ends.  Depending on the amount of work needed for the rhinoplasty will determine the cost.  This will also vary among surgeons as well as your geographic location. 

Discuss your issues and complaints with a board-certified plastic surgeon to discuss these as well as to examine and assist you in deciding which procedure(s) will be the best for you. A discussion of the advantages and disadvantages will take place along with the risks and benefits. Insurance companies will vary on coverage and is always reasonable to discuss your issues with your surgeon and primary care. It would behoove you to get as much information as possible and even call your insurance yourself. Certainly, pay in advance prior to your surgical procedure and options such as financing are available if you qualify. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Insurance payment for septoplasty or nose surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

How much insurance will pay for nasal surgery is a very gray area. This is especially true when there is a functional component.

A septoplasty does not change the shape of the nose and is therefore considered a functional procedure as opposed to a cosmetic procedure. As such, it is a procedure that insurance should pay for (as well as facility fees and anesthesia costs). Verification of benefits and prior authorization before surgery should be obtained.

Rhinoplasty is considered a cosmetic procedure. It is very unlikely that insurance will contribute to that portion of the procedure. Even though the rhinoplasty portion of your surgery will be considered cosmetic, the functional component will be covered by your insurance and may decrease your out of pocket expense.

However, for patients with a history of prior nasal trauma and documented symptoms of nasal obstruction, a septorhinoplasty may be covered by your insurance. This terminology denotes that the surgery is performed to correct funcational problems and required reshaping the nose.

Choose a rhinoplasty surgeon who has experience in correcting both functional and cosmetic nose problems. Check to see if the physician's office can assist with your arranging your insurance pre-authorization.

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon
4.7 out of 5 stars 149 reviews

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.