Septorhinoplasty and Blue Cross Blue Shield

Question

I am 18/f. I broke my nose a few weeks ago and my doctor said I should get a septorhinoplasty. I know BCBS will cover the reconstructive part of the operation. The thing is, I have ALWAYS hated my nose. Can I get BCBS to consider a complete reshaping of my entire nose as the "reconstruction" of my nose? Can my surgeon give me the nose Ive always wanted while getting rid of a bump acquired from injury? Do surgeons think it's unethical to reshape it to my preference under insurance?

Houtan Chaboki, MD · Answer

Hi Columbia6571,

	Rhinoplasty is not one operation, but rather many potential procedures to improve the appearance and function of the face and nose. The cost of plastic surgery varies greatly, but it's usually similar for plastic surgeons in your area. Portions of plastic surgery may also be covered by your insurance provider, such as septoplasty or turbinate reduction. Straightening the nose with septorhinoplasty after nasal trauma or broken nose may also be covered. However, each insurance provider coverage plan varies greatly and some plastic surgeons do not participate in surgery.

	The cost of cosmetic surgery involves several charges for the entire service. The total fees may also include cost of surgical supplies, laboratory tests, anesthesia, and hospital operating room charges, in addition to the surgeon's fee for performing the cosmetic surgery.

	Plastic surgery cost depends on several factors, but largely dependent on the following:

	Region - Beverly Hills rhinoplasty more expensive than rural Midwest

	Complexity - Full rhinoplasty treating many parts of the nose and requiring anesthesia is more expensive than simple procedures isolated to specific areas which may be performed with local anesthesia

	Revision surgery - Revision plastic surgery is generally more expensive than primary surgery

	Surgeon - Some plastic surgeons charge significantly more or less than their peers

Etai Funk, MD · Answer

If you have had acute (less than 3 weeks ago) trauma to your nose and notice a significant change in the appearance once most of the swelling has abated, insurance may cover your surgery.  It is important to see your physician as soon as possible after the injury so they can document it with your insurance.  If you broke your nose 3 years ago, are seeing your surgeon for the first time, and now want cosmetic changes to your nose, insurance will likely NOT pay for your procedure.  This is especially true if you want minor tip or other changes made that were likely not an effect of the injury.  

	 

	Furthermore, insurance companies are making it more and more difficult for surgeons to get paid for nasal airway surgery despite it being non-cosmetic.  This complicates matters even more.  Seek a trained rhinoplasty surgeon who has dealt with these insurance issues in the past.

William Portuese, MD · Answer

When a broken nose is straightened back to its normal shape out of medical necessity, it is called an open reduction nasal and septal fracture. Any internal breathing issues can be addressed as well and is submitted to insurance; for repair and straightening of the internal nose to its pre-injury state. Changing the nose shape through cosmetic surgery is paid for by the patient and any cosmetic procedure on the nose can be performed at the same time as any reconstructive procedure. The operating room, anesthesia, and surgeon’s fees are each billed separately for both cosmetic to the patient and reconstructive procedures to the insurance company.

James H. Fuller, MD · Answer

This is a little complicated.

	Most insurance companies, including BC/BS of Florida will pay for a rhinoplasty within a year of the injury for a deformity arising from a fracture that occurred while the insurance was in effect. My practice is to incorporate any reasonable patient request into the procedure. One must understand that insurance companies do not reimburse enough to cover the cost of a cosmetic rhinoplasty. Then there is the problem of the doctor not being able to bill the patient beyond the insurance reimbursement. That means your surgeon is unlikely to do everything the patient wants for the insurance payment.

	However (and this may be unusual) I have an arrangement with my local hospital where I do about 10 to 12 hours of surgery twice a week and they want to keep me there. Basically, if I am already doing a septoplasty paid for by insurance the hospital charges a very minimal fee and anesthesia does not (so far) charge extra and I charge the patient a discounted fee for a cash payment to do the rhinoplasty - recent fracture or not.
	You will not likely find this to be a common practice.

Samir Shureih, MD · Answer

There should be documentation that the nose was actually BROKE, can have CT Scan. Also document that the beak have caused the deformity and that the surgery is to correct the deformity as a result of the trauma.

	You say " always hated your nose" Do not expect the insurance to pay for cosmetic rhinoplasty, this is fraud.

	You want cosmetic rhinoplasty then you need to pay for the surgery.

	If the doctor lies to the insurance company this is fraud and can cost him/her their license to practice medicine.

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