I have swollen turbinates and was thinking of getting surgery for it so I could breathe easier, but I also was looking into getting rhinoplasty surgery as well, so would the insurance that covers my turbinate procedure also cover my rhinoplasty procedure, or part of it?
October 1, 2013
Answer: Functional and Cosmetic Surgery: Who pays?
I generally keep things as separate as possible, as to avoid any confusion for the patient and the carrier.
Cosmetic is Cosmetic, and it should not be billed to an insurance company under a functional umbrella. You are only asking for trouble if you do that. It is likely that the carrier will review the clinical information and deny the whole case, leaving you with the entire bill. From a provider standpoint, it really is fraudulent to do so.
That being said, insurance can and should pay for functional surgery. Taking this approach, patients will generally avoid >50% of the facility/anesthesia fees and a portion of the professional fees. It can make a substantial impact on cost to combine functional and cosmetic surgery into a single procedure.
This approach also allows the doctor to give you a concrete number for your out of pocket costs, rather than a situation where you may get reimbursed if and when your insurance pays out.
Best of luck and hope it works out for you
Helpful
October 1, 2013
Answer: Functional and Cosmetic Surgery: Who pays?
I generally keep things as separate as possible, as to avoid any confusion for the patient and the carrier.
Cosmetic is Cosmetic, and it should not be billed to an insurance company under a functional umbrella. You are only asking for trouble if you do that. It is likely that the carrier will review the clinical information and deny the whole case, leaving you with the entire bill. From a provider standpoint, it really is fraudulent to do so.
That being said, insurance can and should pay for functional surgery. Taking this approach, patients will generally avoid >50% of the facility/anesthesia fees and a portion of the professional fees. It can make a substantial impact on cost to combine functional and cosmetic surgery into a single procedure.
This approach also allows the doctor to give you a concrete number for your out of pocket costs, rather than a situation where you may get reimbursed if and when your insurance pays out.
Best of luck and hope it works out for you
Helpful
October 1, 2013
Answer: Insurance generally covers functional nose surgery only.
Insurance will probably cover the functional operation on your airway. It is unlikely that it will cover the cosmetic rhinoplasty. These two operations are commonly done together.
Helpful
October 1, 2013
Answer: Insurance generally covers functional nose surgery only.
Insurance will probably cover the functional operation on your airway. It is unlikely that it will cover the cosmetic rhinoplasty. These two operations are commonly done together.
Helpful