I have an excellent insurance (Kaiser) and already saw a specialist there regarding combined rhinoplasty/septoplasty and got a quote. However, I'd rather have a procedure with a more experienced and well known doc privately practicing. I know that the combined procedure should be partially coevered by my insurance but my question is: who would go about contacting insurance to cover this partial cost ? Would I have to do this on my own or would the doctor's staff help with figure out billing ?
Working with Insurance to Offset Costs of Rhinoplaplasty/Septoplasty
Doctor Answers 5
Insurance for nose surgery
Our office contacts the insurance to try and obtain coverage for a procedure like a rhinoplasty or septoplasty. You may have a problem for if you have Kaisder, they will not cover you having surgery done by an outside plastic surgeon. Watch our videos!
Insurance coverage for rhinoplasty
Thanks for the question. Insurance coverage can certainly offset a significant portion of the cost of rhinoplasty if the patient also has medical (non-cosmetic) concerns. These can include difficulty breathing through the nose, deviated septum, narrowing of the internal valves of the nose, large turbinates, prior nasal fracture with crooked nasal bones, and septal perforation, among others.
The degree to which insurance will cover a given set of procedures varies widely depending on the insurance company, your specific plan, your deductible, the contracting status of the surgeon and anesthesiologist (in or out of network), and the surgery center or hospital at which your case is performed.
Because functional and cosmetic rhinoplasty comprise a large part of my practice, I have front office staff to handle the insurance inquiries and billing. We are contracted with a number of insurance companies. Typically when you arrive for your rhinoplasty consultation, the receptionist takes a copy of your insurance card while you fill out the registration forms. Next, I meet with you for approximately an hour to discuss your concerns, examine your nose, perform computer imaging, and discuss the surgery and recovery in detail. Afterward, my surgical coordinator provides you with a breakdown of the amount of time needed for the medical and cosmetic portions of your surgery as well as a quote detailing your out-of-pocket costs for the cosmetic portions. Later, she will call your insurance company to obtain a prior authorization to determine your benefits/eligibility and find out if any additional letters, clinical notes, or photographs need to be submitted. All of this process is coordinated on our end and the patients are generally not required to call the insurance companies themselves.
Rhinoplasty and insurance coverage for septoplasty
If you would prefer to stay with your Kaiser insurance:
I would recommend a consult with Dr. Amir Rafii at the SF Kaiser Group to help you make your decision.
Otherwise, other insurance plans may occasionally cover some portions of a septoplasty and function complaints if you meet criteria.
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Insurance coverage for a rhinoplasty
You have Kaiser insurance which only pays for treatment at Kaiser facilities. Having any surgery outside that system would be totally out of pocket. Many plastic surgeons have accredited office operating rooms which help to keep costs down.
The septoplasty may be covered by your insurance.
Your chosen doctor may be able to write a letter of preauthorization for the surgery and coverage. You need to follow up with your insurance and be persistant. (the contract is between you and the insurance). Initial approval by the insurance does not guarantee payement.
Your policy may nor allow you to go ouside the insurance participating doctors. Cotact your insurance and talk with your chosen doctor
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.