Will a Septo-Rhinoplasty Be Covered by Insurance?

Question

I have a deviated Septum, and after consulting an ENT found out that Septoplasty is the best option for me. However, I also have a bump on my nose that I would like to remove and I was wondering if my insurance would cover the procedure if my surgeon shaved off the bump while he's fixing my deviated septum. If I write down on the insurance information that the PRIMARY reason for the surgery is for medical reasons, would my surgeon be able to perform both procedures at once?

Jerome Edelstein, MD · Answer

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.

Lewis Albert Andres, MD · Answer

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!

Earl Stephenson, Jr., MD, DDS, MBA · Answer

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

Anil R. Shah, MD · Answer

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.

Toby Mayer, MD · Answer

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.

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