Will medicare pay for a broken nose that's causing these problems?

Question

I have medicare with a supplement. Lately I've been unable to breathe and have been disturbing others with my snoring. I'm sure I have a deviated septum but do I have that because of a broken nose? I realize that the rhinoplasty is considered cosmetic, but there must be some situations in which it can be covered if it interferes with well being.

John Michael Thomassen, MD · Answer

If you have breathing obstruction from a septal deviation being secondary from trauma or congenital, the insurance should cover this.  If any cosmetic changes are done at the same time, these would be considered out of pocket expenses.

Kris M. Reddy, MD, FACS · Answer

Each plan is different and reimbursement from insurance is becoming increasingly difficult. Medicare should reimburse for septal deviation and other functional issues. However, the process of reimbursement is such that many surgeons are requesting payment prior to surgery.

Kathleen Waldorf, MD, FACS · Answer

Hi and thanks for posting this question!
You will have to verify this generalization with your individual insurance carrier:
Nasal surgery addressing the septum for reasons of breathing difficulty or to repair traumatic injury is generally covered by insurance companies.
Nasal surgery to improve the appearance of the nose is considered cosmetic and is an out-of-pocket cost to the patient.
The best way to find out if you meet the criteria for insurance coverage is to be seen and evaluated by a reputable, board certified specialist in nasal surgery (either plastic surgeon or ENT surgeon).

Best wishes

Darryl J. Blinski, MD · Answer

Usually 50% is covered while the other 50% is considered cosmetic and you would have to pay out of pocket.

Juris Bunkis, MD, FACS - Account Suspended · Answer

You can expect insurance to pay for functional problems like septal deviation and difficulty breathing.     It will not pay for the cosmetic part, changing the appearance of your nose.    Go see a good nasal surgeon and find out what will be covered and what will not.

Will medicare pay for a broken nose that's causing these problems?

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