Insurance Coverage for Septoplasty

I'm 17, and my nose was broken when I got hit in the face several times during childhood. It resulted in deviation of septum, fractured nose, and breathing problems. I have Americhoice by United Healthcare Insurance without out of network benefits. Rhinoplasty wouldn't be covered, but what about the Septoplasty? Does anyone know a doctor who could perform both Rhinoplasty and have the Septoplasty covered?  In line with this, would it be a good idea to have two surgeons perform Rhinoplasty and Septoplasty (covered) separately, or just one ENT surgeon? Some mentioned it would be affordable.

Doctor Answers 15

Insurance Coverage for Septoplasty

You are approaching it the wrong way.

Your first question should be, 'What do I want?' Better breathing, better looking nose, or both.

Septoplasty is easy and any ENT surgeon can do it for you. You should be able to find someone in your network.

Rhinoplasty is a whole different ball game. You want it done once and done right. Trying to save some money you might end up with a poor result. If money is an issue you should only get septoplasty and save money for a rhinoplasty down the road.

I see that you are new york. The best guy in my opinion to do a rhinoplasty in NY is Dr. Norman Pastorek.

Goodluck and regards

Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 107 reviews

Insurance coverage

Great question. Generally speaking insurance does cover septal surgery. In fact most insurance plans will cover any nasal surgery that is designed to help improve your breathing, including some rhinoplasty techniques. However many of the finer details that go into making a nose look more aesthetically pleasing are not covered by insurance because they have no impact on you ability to breathe. A nasal or dorsal hump would be the classic example. Even a very large hump is likely to have no real impact on your breathing thus removing it would not typically be covered. That being said many patients have had success getting a nasal surgery that improved breathing but may also improve symmetry covered by their insurance plan. Hope this helps. 

Julian W. Dixon, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Insurance for Septorhinoplasty

Many patients want both a functional correction of their nose as well as a cosmetic correction.  The functional portions of the case, such as septoplasty, are typically covered by insurance.  Each insurance plan is unique, so insurance plan benefits can be determined before the procedure to see what your anticipated coverage would be.  

A rhinoplasty is not covered by insurance and the cost is dependent on the surgeon's fee.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 162 reviews

Septoplasty covered by Insurance at the time of cosmetic rhinoplasty

Performing medically necessary septoplasty along with cosmetic rhinoplasty is quite common in my practice.  I have not had difficulties working with the insurances, and all the pre-authorization is arranged for you by my office.

Prices for rhinoplasty with or without septoplasty will definitely vary with geographic location and with the level of training of your surgeon.  There are serious advantages both in terms of cost and post-operative healing to combining procedures into a singe surgery.  If you are having trouble breathing or recurrent sinusitis related to a deviated septum, I would STRONGLY recommend that you see a board certified ENT prior to undergoing surgery.  You are correct that insurance will cover the cost of septoplasty (you may require turbinate reduction as well- this will have to be determined on examination) and the anesthesia time associated with the septoplasty and turbinate reduction. The cost of the tip rhinoplasty and cosmetic operating room and anesthesia fees are the fees that you will need to pay out-of-pocket, and these fees can vary greatly depending upon the subspecialty training of the surgeon you choose and the facility in which they operate.
In terms of healing, it is easier to have a single surgery to recover from than multiple surgeries.

Technically, if you are thinking about having a rhinoplasty, you should definitely wait to do your septum until you do both procedures at the same time.  Properly performed rhinoplasty often requires multiple cartilage grafts to reinforce the new structure for your nose.  The easiest place to obtain these cartilage grafts is from your own septal cartilage.  If you were to go ahead with a septoplasty, and then decide to do your nose in a few years, your surgeon would lose the ability to use your own septal cartilage for these grafts and would have to seek out other sources for cartilage, such as your ear cartilage.  It is definitely best to do both septoplasty and rhinoplasty at the same time.

While cost can vary, in my practice (upper east side of Manhattan), the cost is approximately $4000 surgeon's fee for a primary rhinoplasty, and $2,000 to the operating room and anesthesia, for a total of around $6000 out of pocket.  Please bear in mind that this is just an estimate based on the information you provided.

I will end by saying that while cost is a consideration for almost everyone, I counsel my patients that the most important thing in choosing a surgeon, assuming that you are choosing among equally qualified and capable surgeons, is choosing a surgeon who's aesthetic and opinion you trust.  Aesthetic surgery is a little bit science and a little bit art.  Inevitably, your surgeon will need to make decisions for you while you are asleep that will impact your final result, and you need be comfortable that you and your surgeon are on the same page in terms of the goals of surgery and what you consider to be a beautiful result.  I find that pre-operative imaging really helps make sure that me and my patient are indeed on the same page.

Dara Liotta, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 30 reviews

Insurance Coverage for Septoplasty

As you suggest, Americhoice will most likely cover the septoplasty but not the rhinoplasty if it is deemed to be for cosmetic purposes. The same surgeon can perform a covered procedure and noncovered procedure at the same time without risking coverage. Consult your plans to ensure that you receive proper documentation from both the surgeon and any supporting physicians.  

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 39 reviews

Americhoice coverage for septoplasty

You are correct that, while septoplasty be covered by insurance, the insurance company will not pay for rhinoplasty. Americhoice is a Medicaid derivative run by United Healthcare. It operates by different rules than other United products. You should consult the United web site, which is one of the better ones in the industry and to read the requirements for coverage of the septoplasty. You do not need two surgeons. Both ENT and plastic surgeons are trained to perform this operation. I disagree that the insurer is more likely to approve surgery not performed by a plastic surgeon. It has a checklist of prerequisites that the patient must meet, including non-surgical management of difficulty breathing, in order for approval to be forthcoming.

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 39 reviews

Septoplasty and Rhinoplasty and billing Insurance

The Septoplasty portion of the procedure should be covered by your insurance as this is for the functional portion of the procedure. The cosmetic portion the rhinoplasty is typically not a covered procedure. Most surgeons do these in conjunction with each other at the same time when requested by the patient. You want to go to a surgeon that is skilled in this procedure and that is not always one that is in your preferred provider plan. I would suggest consulting with several surgeons, reviewing their before and after photos and speaking with their patients who have undergone the same procedure. I use digital Imaging in my practice which will show the consulting patient the proposed results prior to surgery. This may be helpful to you as well in deciding upon the aesthetic Look you desire. Best regards!

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 208 reviews

No Out of Network Benefits

You need to contact your insurance carrier. They will give you the names of "in network" surgeons that will cover your surgery. If your nose was broken while you were under this same insurance, the cosmetic portion might be covered as it was caused by trauma, unless it has to be corrected within a certain time frame. If you have different insurance from when the injury happened, you need to find out if you have a "pre-existing" clause. Again, contact your insurance carrier as they will be able to give you referrals to help you find a surgeon, and tell you what your specific policy does and does not cover.

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 75 reviews

Nasal surgery and insurance coverage

Health insurance should cover both Septoplasty and rhinoplasty in your case, as the deformity was caused by trauma.  Having said that, unfortunately many insurance companies try to get out of paying legitimate claims, and having a surgeon that would also be a good advocate on your behalf  with the insurance company would help.

Typically a skilled surgeon should be able to properly execute both rhinoplasty and Septoplasty at the same time.  Make sure you interview 2-3 surgeons, find out about their experience with your type of deformity and expected outcome both functionally and aesthetically.

Boris M. Ackerman, MD
Newport Beach Plastic Surgeon
4.7 out of 5 stars 56 reviews

One surgeon - both covered

While every insurance policy is different, most will cover septoplasty without much of a fuss. Some will require advance notification and precertification. Some insurance will also cover FUNCTIONAL rhinoplasty. Rhinoplasty simply refers to reshaping of th nose. In some cases, the reshaping must be done to improve the ability to breath through the nose. In other cases, it is purely cosmetic. For functional rhinoplasty surgery, some insurance will provide reimbursement. Again, it is best to get advance notification through a predetermination of benefits. In either case, an ENT or facial plastic surgeon can most certainly perform both procedures in one setting.

D.J. Verret, MD
Dallas Facial Plastic Surgeon
3.9 out of 5 stars 14 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.