Will a Septo-Rhinoplasty Be Covered by Insurance?

Insurance generally covers procedures that are to improve function and your health, but not those that are just for aesthetic purposes. Your septoplasty may be covered but not the rhinoplasty.  

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.  Typically the septoplasty will be covered but not the rhinoplasty portion.  Anesthesia and facility fees should begin once the septoplasy portion ends.  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!

Hi mrsfredweasley in California,

The majority of cosmetic surgery is elective, so insurance plans don't usually cover it. However, there are exceptions. Remember, plastic surgery covers a broad area of medicine which includes both reconstructive procedures and cosmetic procedures. If your procedure is medically indicated, some portion of the cost may be covered.

Septoplasty, or surgery to improve a deviated septum, is normally covered by insurance plans. However, cosmetic changes to the external nose, such as reducing a bump or refining the nasal tip is not covered. Only after a comprehensive evaluation by a rhinoplasty surgeon, can he/she help determine appropriate options for you. Best of luck.

Dr. C

Septal surgery for an obstructive nasal issue is usually covered medical insurance.  The hump on the bridge of your nose usually does not cause any functional problems with your nose.  The fact is that the hump is unattractive therefore it is a cosmetic procedure.  These two procedures are commonly performed together.  

Dr. ES

Cosmetic changes to the nose are never covered by insurance.  Problems which are related to breathing such as a deviated septum may be covered by insurance.  In addition, problems which are related to trauma, such as a crooked nose after a hit to the nose may also be covered by insurance.  

There are many benefits to having surgery which improves breathing and functionality of the nose coupled with cosmetic changes to the nose at the same time:


Patient can have one operation to correct two different issues and therefore one anesthetic and one recovery period

Overall cost is typically much lower to combine procedures than to perform them at separate times

Cartilage which has been removed during the functional portion of the case can be used for the cosmetic case.  Most surgeons "throw away" the cartilage during a septoplasty (I do not).  If this cartilage is removed and thrown away, and a planned separate subsequent procedure would be much more complex and may require either auricular (ear) grafting or costal (rib) grafting

There is some overlap between the cosmetic and functional portions.  For example, straightening a septum (which can be highly complex- see attached link to a paper I wrote on open septoplasty techniques) is often necessary in creating a straight nose from the frontal view.  Failure to address this issue can leave the nose worse off both cosmetically and functionally.


The nose is a highly complex structure and requires a surgeon of expertise in handling both functional and cosmetic issues.  If you do have a functional issue and are considering cosmetic changes as well, it is worth your time to make sure you decide one way or the other before your procedure.  Otherwise, if you seek cosmetic changes later after a standard septoplasty technique (more than 90% of surgeons use a submucous resection technique)  your rhinoplasty will be much more complex.

The removal of the bump and any tip work will not be covered unless it is in some way contributing to your breathing problem. Your surgeon can answer the question after examining your nose.

Septoplasty surgery to correct a deviated septum may be covered by insurance if it causes respiratory difficulties or other medical problems. In addition, you need to check with your insurance company regarding specific policy since surgery for asymptomatic septal deviation may be denied. Hump removal for cosmetic reasons will most likely be denied as well. 

Hello, Mrs. W.

Good thinking re combining the breathing surgery with the cosmetic surgery.

Insurance covers correction of the deviated septum if it is causing breathing problems. Check with your insurance agent or your companies HR department, regarding the specifics of your policy. Very important; assume nothing.

However, generally insurance covers the breathing operation. It will not pay for the bump removal which is a cosmetic issue. In your favor is that if you add the cosmetic procedure onto the surgical plan, the extra charge for the bump removal should be very reasonable.

Ask the doctor for an exact quote based on what information you and the office get from insurance company. There should be no guesswork.

 

Robert kotler, MD, FACS

Beverly Hills, CA

Your insurance is likely to cover septoplasty, but not the bump removal.  Anything that is done to improve or change the appearance of your nose is considered elective and is not covered by insurance.  The patient would be financially responsible for the hump removed.

Only partially will there be insurance coverage because part of the operation is deemed cosmetic. So shall we say half is insurance and half is cosmetic or self pay. That is the general rule of thumb. Yes both can ber done by one surgeon at the same operation.