If I Need Septoplasty & Opt for Cosmetic Surgery to Straighten the Bridge (From Past Trauma) Would Insurance Cover Any of This?

I have a deviated septum plus a crooked nose from an injury when I was a kid and my nose has changed over the years and it slantes to the left a bit. I have trouble breathing, especially at night, I snore terribly, and was curious if insurance would cover septoplasty and anesthesia? i understand i Pay for rhinoplasty and anything cosmetic of course.

Doctor Answers 11

Insurance coverage when functional septoplasty and cosmetic rhinoplasty are combined

Thanks for your question.  To begin, insurance does sometimes cover changes made to the outside (cosmetic appearance) of the nose after trauma, but generally, this is only in the immediate period after acute trauma.  As you suspect, cosmetic changes to the nose after trauma as a child will generally NOT be covered.  

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 the doctor's office prior to the procedure. 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 single surgery.  If you are having trouble breathing, or having 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 a medically-necessary septoplasty (you may require turbinate reduction as well- this will have to be determined on examination), and insurance will also cover the anesthesia time associated with the septoplasty and turbinate reduction.

The cost of the 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.

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.  Additionally, In terms of healing, it is easier to have a single surgery to recover from than multiple surgeries.

While cost can vary, in my practice (upper east side of Manhattan), the cost is approximately $4000 surgeon's fee for a primary rhinoplasty when combined with functional surgery such as septoplasty, and $2,000 to the operating room and anesthesia, for a total of around $6000 out of pocket.  Please keep 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.

New York Facial Plastic Surgeon
4.9 out of 5 stars 30 reviews

Rhinoplasty and Insurance Coverage

The fact that the trauma occurred when you were a child is a potential strike against you.  That said, if you can document the fact that you're having trouble breathing--especially if measures such as an airway pressure device have been recommended--you may be able to convince your insurance company to cover the functional part of surgery.  Crass though it may sound, the key is to persuade your carrier that covering part of your rhinoplasty will pay off for them in the long run.

Call your carrier and ask lots of questions about coverage.  See if you can get a written response detailing what they will and won't do.  As you arrange consultations with experienced rhinoplasty surgeons, enlist the help of their staff as well.  They are trained in working with insurance companies and can help clarify what you can expect.  In any case, the best you can probably hope for is that a portion of your procedure may be covered.

Elliot Jacobs, M.D.
New York Plastic Surgeon

Elliot W. Jacobs, MD
New York Plastic Surgeon
4.5 out of 5 stars 35 reviews

If often depends on your insurance company

We get this question a lot?  If your nose needs to be straightened in order to improve your breathing, you can make a case for the insurance company covering part of  the surgery, but they usually to not.  Your septoplasty might be covered, but the anesthesia, facility charges and surgeon's fees related to the cosmetic surgery will not be covered. 

Stuart H. Bentkover, MD
Boston Facial Plastic Surgeon
4.5 out of 5 stars 25 reviews

Insurance Coverage after Nasal Trauma

In general we tell patients that insurance frequently pays for that part of the surgery that improves nasal function. Because this can be very confusing my staff will help patients by contacting their insurance company after consultation to clarify their benefits.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 39 reviews

Septorhinoplasty after trauma.... Who pays?

For anything related to nasal congestion, your insurance company will generally pay PROVIDING permanent & detrimental airway obstruction that is not relieved by any allergy medications has resulted from the trauma and/or the deviated septum. For anything external, your surgeon might be able to submit codes for an insurance claim for re-breaking your nasal bones and setting them straight, PROVIDING you can document the prior nasal trauma with an ER visit and/or xrays illustrating a nasal fracture. If no such records exist, you can probably plan that the insurance company will only pay for anything "internal" (medically necessary) and you will pay for anything "external" (cosmetic).  

Randolph Capone, MD, FACS
Baltimore Facial Plastic Surgeon
4.7 out of 5 stars 51 reviews

Insurance and septoplasty

Some insurance companies will cover septal deviation and reconstruction. Best to check with your insurance company to see what they require to give approval.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Septoplasty and rhinoplasty combined

 A septoplasty  is performed to improve airflow dynamics through the nose and repair a deviated septum. A rhinoplasty is performed to straighten the nasal bones and changed the shape of the nose externally. Both procedures can be performed simultaneously under one anesthesia. All the incisions for both procedures are placed inside the nose also known as closed rhinoplasty. Please see  the link below for our Virtual Rhinoplasty App  and our  Rhinoplasty photo gallery.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

If I Need Septoplasty & Opt for Cosmetic Surgery to Straighten the Bridge (From Past Trauma) Would Insurance Cover Any of This?

       The deviated septum that is believed to contribute to breathing difficulties will usually be covered by insurance.  Straightening or cosmetic work to correct damage from a remote trauma is not likely to be covered.  Find a plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties and rhinoplasty revisions each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

If I Need Septoplasty & Opt for Cosmetic Surgery to Straighten the Bridge (From Past Trauma) Would Insurance Cover Any of This?

Dear Laura,

Thank you for your question.  Different insurances cover different things based on your plan.  IF there was an acute trauma with nasal fracture, insurance would cover straightening the nose.  Trauma from when you were a kid may be difficult to get covered.

best wishes,

Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 48 reviews

Insurance may or may not cover a crooked nose after trauma.

Insurance generally will pay for any functional improvement to the nose with or without antecedent trauma. Whether they will cover cosmetic damage is inconsistent. Your plastic surgeon can help you with this.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 36 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.