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?
March 21, 2011
Answer: Insurance and Rhinoplasty
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.
Helpful 2 people found this helpful
March 21, 2011
Answer: Insurance and Rhinoplasty
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.
Helpful 2 people found this helpful
March 18, 2011
Answer: Rhinoplasty
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.
Helpful
March 18, 2011
Answer: Rhinoplasty
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.
Helpful