Would Insurance cover any part of the hospital fees if you get a Septoplasty with your Rhinoplasty?

Question

I have a deviated septum, and want to get a Rhinoplasty? Would Insurance only pay for the Septoplasty fee, or would they also chip is for some of the Hospital costs and anesthesia?

Manish H. Shah, MD, FACS · Answer

Hello Austinou88,Thanks for your question.If insurance will cover your septoplasty, then it typically will cover some of the hospital fees and anesthesia cost.Discuss this with your insurance provider ahead of time.Good luck,Dr. Shah

Theda C. Kontis, MD · Answer

While coverage varies by individual policies, usually septoplasty is a procedure that is considered to cause functional breathing problems and typically insurance will cover the surgery. I tell my patients to consider the surgery like 2 surgeries, each with separate surgical, facility and anesthesia fees.

Sandy Sule, MD · Answer

In general (please contact your insurance company for further details) if you are diagnosed with a septal deviation requiring a septoplasty, insurance with cover the surgeon, anesthesia, and hospital fees (to the limit of your coverage). The rhinoplasty part would not be covered by insurance.

William Portuese, MD · Answer

It is important to review the policy booklet issued with your medical insurance for coverage details. Every insurance company has different parameters on what may or may not be covered. At   the time of examination and consultation, medical necessity must be documented for the septoplasty which can  then be billed to the patient's medical insurance. Co-pays and deductibles will apply on the allowed amounts for that component of the surgery. The rhinoplasty procedure is considered cosmetic, and that component must be paid for by the patient which includes time in the operating room, anesthesia, and the surgeon's professional fees for the cosmetic component. The septoplasty component takes approximately half an hour, while the rhinoplasty component usually takes approximately 1-1/2 hours. Performing the surgery in outpatient surgery center is much cheaper than a hospital for the patient. For more information about the differences between  a septoplasty and a rhinoplasty, please see the link and the video below

Michael R. Lee, MD, FACS · Answer

Most insurance policies cover portions of a rhinoplasty that deal with airway obstruction.  This usually includes septal deviation and turbinate (large bone inside the nose) reduction surgery.  Occasionally, insurance may cover nasal valve repair.  Most other changes are not covered.

William Marshall Guy, MD · Answer

Hello Austinou88,WHat insurance actually covers is always difficult to predict.  If you have documentation of a deviated nasal septum and a septoplasty is indicated, they will usually pay for hte septoplasty portion of hte procedure as well as a part of the operating room fee and anesthesia.  Some companies will pay a flat amount for this and others a percentage depending on whether you have it perofmred in a hospital or surgical center.  Once the rhinoplasty part begins then it would be all cosmetic.  I'd recommend you discuss this with your surgeon.  You can sometimes obtain a preauthorization to determine what would be covered.I hope this helps and good luck.

Kailash Narasimhan, MD · Answer

Thank you for your question, it is getting harder these days for insurance to cover a septoplasty and rhinoplasty. If your insurance covers these procedures, you will generally need to send a precertification to document trauma or deformity in order for the insurance to cover it.  If there is a cosmetic portion of the procedure that you would like, make sure you discuss this with your surgeon. There needs to be a clear distinction about the cosmetic and reconstructive portions of the procedure. In our state approved operating room in Sherman Texas, we perform these procedures. Please also have a discussion with your provider, regarding the operation itself and recovery.

Babar Sultan, MD · Answer

Its fairly common for septorhinoplasty to have a combination of functional and aesthetic changes.  Insurance can cover a portion of your surgeon, anesthesia, and facility fees.  Its important to communicate with your surgeon's pt coordinator and obtain pre-authorization from your insurance if necessary.Wish you the best!

Brian Vassar Heil, MD - Account Suspended · Answer

Dear Austinou88, this is a great question. Insurance providers typically only cover those procedures that are medically necessary, and seldom ever cover cosmetic procedures (i.e. ones that may improve your self-esteem, but won’t improve your physical health).  Therefore, it is highly likely that your insurance will cover most of the fees associated with your septoplasty, but I doubt that they would cover expenses for the rhinoplasty, unless your nose was broken or in some other way damaged and needs to be repaired.

Michael Elam, MD (retired) · Answer

Dear Austinou88, When patients come to my office with a dual diagnosis of breathing difficulties and aesthetic concerns then we discuss the procedure of septorhinoplasty. This is the combined procedure of septoplasty and rhinoplasty.  The insurance billing agent will determine the benefits a patient has and the percentage of costs that will be covered and then the patient is quoted a fee prior to the scheduling of the operation. Best regards, Michael V. Elam, M.D.

Would Insurance cover any part of the hospital fees if you get a Septoplasty with your Rhinoplasty?

Answers (11)

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