Personal experience with septoplasty
Having just had a septoplasty 3 weeks ago, I can speak a bit about this matter from the patient's perspective as well as the doctor's. First of all, many of the very best surgeons don't take medical insurance anymore because of the paltry reimbursement paid to the doctor. You must realize, though many patients don't, that your surgeon is usually only paid a small fraction of the bill by the insurance and the amount is getting smaller all the time as costs rise to do the surgery and run an office, pay staff and all the bills. Therefore, if your surgeon has the kind of reputation of being the best and has enough patients willing to pay his or her fee, they will thrive while working out of the insurance network.
Remember, however, that septoplasty should be an insurable "medically necessary" procedure and there are many doctors who will do it totally through insurance. They just might not be the best at doing it. All surgeons are different in their talent, skill, training and experience. Personally, I believe you should go to the best and hopefully only have to do the operation once. Revisions never get to the same outcome as a well done one-time operation!
I took my own advice and went to Dallas where the best surgeon for me happens to be located. He is a doctor's doctor. I had a very complex septal obstruction and he has resolved it beautifully in a complex surgery lasting 3 hours. Consequently, I am extremely happy I went that way and would do it again in a heartbeat. I paid up front for surgery and will try to get something (not much) back from my insurance after the fact. The facility and anesthesia are being billed directly to my insurance. The fees you describe seem high though and you might exlpore other options. The surgeon I went to is Dr. Jack Gunter. There are none better in my opinion. I hope this personal story helps!
Unfortunately, there is no single price for a self-pay septoplasty.
A septoplasty is a procedure that helps improve nasal breathing. While it is typically billed to your insurance company and is a covered service under most plans, some surgeons don't accept insurance and bill the patient directly. (To bill an insurance company AND the patient simulataneously for a septoplasty is not allowed.)
If we consider a self-pay septoplasty, the fee is variable and up to your surgeon to determine. Some people have already had a septoplasty and need further work, or a REVISION septoplasty. Revisions are always more difficult to perform and therefore the cost is more. Some people also have a hole in their septum (septal perforation), and a septoplasty with septal perforation repair will certainly cost more.
If your surgeon is very busy and highly respected for his septoplasty work, he will no doubt charge a higher price because he's an expert. Another factor is geography. A self-pay septoplasty will likely be more costly in a large metropolitan area like NYC, or a plastic surgery hotbed like Beverly Hills. If you were to go to a rural area, the local ENT will almost certainly charge less. This difference is often significant, and can be several thousands of dollars.
The other (often over-looked) fact is that your doctor may be performing more than just a simple septoplasty in order to make you breathe better. He may also be performing a nasal valve reconstruction with turbinate reductions as well as some cosmetic refinements to your nose simultaneously. This most definitely will drive your bill up since so much work is being done to improve your breathing.
Cost Varies: Expect $4,000-$5,000
Septoplasty is a commonly performed surgical procedure.Prices for this procedure very widely and
depend on several variables.It’s
important to make sure that your fee quote includes the surgeon’s fee, facility
fee, anesthesia charges and pre and post-operative care.These components may vary widely depending on
the surgeon’s practice.
surgeons who operate in dedicated outpatient cosmetic surgery facilities are
able to offer lower facility fees than those who operate in hospital based
practices.Anesthesia fees can vary and
this may be related to the use of a nurse anesthetist verses a physician
the physician’s fee may vary depending on regional differences and local
competition.It’s also important to
understand the surgeon’s revisional surgery policies.Hopefully this won’t be necessary, but
revisions occur for a multitude of reasons.
all these variables are considered, fees in the Midwestern United States vary
from $4,000 to $5,000.It’s important to
remember that price is an important part of your decision, but it’s not the
only consideration.Make sure your
surgeon is board certified, has a good reputation and experience performing
Typically $3,000 to $4,000
Cost for a septoplasty including the operating room, anesthesia, and the surgeon’s fee is in the $3,000 to $4,000 range, not $14,000 to $20,000 range. Once the medical necessity has been documented by the surgeon, the septoplasty is billed to the patient's medical insurance. Patient's are still required to pay the co-pay and deductibles based on their current insurance plan.
Cost of Septoplasty...Does That Include an Arm and a Leg?
That's a lot of septum! A reasonable fee for septoplasty alone including operating room and anesthesia (1 1/2 hour) should be less than half of your surgeon's fee, without including the operating room and anesthesiologist. If you have a large septal perforation then the price may be high, but within range of reasonable.
For the price that you were quoted, you can choose a great surgeon, say in Los Angeles, stay in a four star hotel suite in Beverly Hills, and fly onto to Hawaii for a week to test your sense of smell on those Maui orchids before returning home to the chilly confines of Soldier Field, I mean Chicago.
I would get some other opinions in Chicago where there are many very fine septo-rhinoplasty surgeons. Good luck and be well.
Thank you for your question. Septoplasty is a
surgical procedure which generally entails modification of the cartilage of the
nasal septum. It is undertaken to improve symptomatic nasal airway obstruction
when deviation or crookedness of the septum is judged to contribute to those
symptoms. Since this procedure is usually undertaken for functional breathing
reasons, it is usually covered by medical insurance. There is no one price that
can be accurately referenced. Rates of reimbursement vary widely between
insurance companies and policies and are ever-changing. For the most accurate
and updated information, ask you surgeon's office about fees and financial
policies. Good luck to you.
The cost for a procedure can vary depending on the complexity of the procedure, geography where you live, and indivdual pricing for the surgeon. Typically pricing for a noncomplex septoplasty is significantly lower and can range from $1000-6000, excluding the cost of anesthesia and facility fee.
Thank you for the great question. The unfortunate truth is that, in our current healthcare system, costs and bills are basically a black box. Many surgeons have reacted to this by not accepting insurance, regardless of medical necessity. In my practice, if a patient needs a septoplasty or some other functional nasal surgery, I work with the patient's insurance company for reimbursement. Though I do not accept every insurance plan, this procedure is typically deemed medically necessary and I treat it as such.
$14000 surgeon's fee for septoplasty alone sounds excessive
I think that your instincts are correct in that the $14000 figure quote sounds excessive for septoplasty alone. However, first make sure that the surgeon is planning on performing only a septoplasty, and not a more complicated procedure such as a septorhinoplasty or functional rhinoplasty. Insurance companies will typically cover the cost of a septoplasty, but many will now balk at covering a septorhinoplasty. They are two very different operations in that a septorhinoplasty has the possibility of making changes to the external nose, the operation is longer and more complicated, and the recovery takes longer.
If it's just a septoplasty, then I would seek consultation with other nasal surgeons. Some surgeons would rather not have to deal with the insurance companies due to declining reimbursement rates. In our practice, all straight septoplasties and functional (not aesthetic) septorhinoplasties are sent for insurance approval. Almost all of the septoplasties end up covered. A high proportion of the septorhinoplasties are denied and this is largely dependent on the insurance company and their ignorance to the fact that not all nasal surgery is aesthetic in nature. If we get a denial, we usually try to appeal it once. If it is again denied, then we write up a quote for it to be paid out of pocket. Even still, this out of pocket cost is about $6000-8000 including all of the fees you listed above. Of course, this varies with the surgeon, and geographic location.
Michael Kim, MD
$14,000 out of pocket does sound high for only septoplasty unless there are other complex reconstruction that is also being done at the same time. However, surgical fees to vary considerably across the country. Consult with three other surgeons in your area to understand your options. The typical fee in South Florida would be about 1/3 to 1/2 of that total.