Help with Tricare and rhinoplasty?

Question

I am medically separated from the military and currently have Tricare. I am looking to get rhinoplasty for multiple reasons. I can’t breathe out of one side due to how crooked my nose is. Also, it’s just plain ugly (crooked, hump, etc). So I’m looking for both cosmetic and health reasons. Is there a way I can get my insurance to partially cover the costs?

Thomas A. Lamperti, MD · Answer

Insurance can potentially cover surgery related to improving your nasal airflow. This can include septoplasty surgery for example. Insurance doesn't cover surgery to smooth down a bump or make the nose straighter as this is considered cosmetic. We'd need to get preauthorization for the functional portion of surgery in advance. This is done after an office consultation and assessment.You can learn more about functional and cosmetic nose surgery at my web reference link below.

William Portuese, MD · Answer

Functional breathing surgery may be a covered benefit under medical insurance, however anticipate co-pays and deductibles when your insurance does participate. Medical necessity and pre-authorization must occur prior to any functionally related surgery.  Nasal surgery to straighten the crooked nose and shave off the dorsal hump is considered cosmetic, and must be paid for by the patient. The cosmetic rhinoplasty component is more complicated, and takes longer to perform than the functional breathing component. Expect to pay for the cosmetic component yourself, while the functional component can be billed medical insurance. A septoplasty for breathing and a rhinoplasty for cosmetic purposes are two completely separate surgical procedures, but both can be performed at same time under the same anesthesia, which allows one recovery period.  Digital computer imaging performed at time of the office setting would be helpful to understand what can be accomplished with a cosmetic rhinoplasty.  For more information about the differences between a septoplasty and a rhinoplasty and our current price list, please see the link and the video below

Help with Tricare and rhinoplasty?

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