Insurance Coverage for Septoplasty

Question

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.

Tanveer Janjua, MD · Answer

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

Anil R. Shah, MD · Answer

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.

Miguel Delgado, MD · Answer

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.

Boris M. Ackerman, MD · Answer

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.

John Diaz, MD · Answer

A good rhinoplasty surgeon, whether they are an ENT or Plastic Surgeon, will be more than capable enough to do both a septoplasty and a cosmetic rhinoplasty.
However, insurance will only pay for the septoplasty portion of the operation.

C. Spencer Cochran, MD · Answer

Septoplasty is a surgery performed to correct a deviated (or crooked) septum. The septum is the piece of cartilage that separates one side of the nose from the other. Normally, the septum is straight. When it is crooked, it is termed a deviated septum. A deviated septum can block the nasal passage and contribute to symptoms of nasal obstruction.
A septoplasty does not change the shape of the nose and is therefore considered a functional procedure as opposed to a cosmetic procedure. As such, it is a procedure (as well as facility fees and anesthesia costs) that insurance should pay for. Verification of benefits and prior authorization before surgery should be obtained. For patients without insurance, the surgeon's fee for a septoplasty can range between $1000 and $2000.  
A septoplasty is frequently performed at the same time as the rhinoplasty.  Your best bet is choosing one surgeon to perform both procedures.  Even though the rhinoplasty portion of your surgery will be considered cosmetic, the functional component will be covered by your insurance and may decrease your out of pocket expense.

Toby Mayer, MD · Answer

Whether you go to an ENT of plastic or facial plastic surgeon, he should be able to do both operations at the same time. Insurance will only pay for the septoplasty.

Sam Jejurikar, MD · Answer

Most plastic surgeons are capable of performing septoplasty, but many prefer getting an ENT colleague involved.  Sometimes, from a practical standpoint, it's easier to get insurance approval for the septoplasty if pre-authorization comes from another surgeon who is distinctly separate from the cosmetic procedure.  Still, many plastic surgeons choose to do their own septoplasties; it's very dependent on individual preference.
If you have a history of breathing problems, and a surgeon documents that this is the result of airway obstruction secondary to a deviated septum, you do have a reasonable chance of getting approval for septoplasty from your insurance carrier.  This is separate from rhinoplasty, but could defray some of the anesthesia and surgery center costs, depending on your location.
Best of luck!

Julian W. Dixon, MD · Answer

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.

Dara Liotta, MD, FACS · Answer

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.