Typically, procedures such as rhinoplasty are considered cosmetic. You might decide to undergo the surgery to improve your appearance and self-confidence, but an insurance company is usually not willing to cover the cost of the surgery if it’s performed for cosmetic reasons. You’ll be responsible for the costs of the procedure.
But, if you need to undergo rhinoplasty or septoplasty for medical reasons, some insurance plans do provide coverage. If you’re getting nose reshaping surgery to repair damage from an injury or to fix a breathing problem, work with your surgeon and your insurance company to make sure the procedure is covered and to make sure everyone is on the same page.
Medically Necessary
Insurance companies don’t pay for elective procedures, or surgeries you choose to receive but don’t need. To qualify for insurance coverage, your rhinoplasty needs to be deemed medically necessary. The exact coverage offered differs by insurance company and by policy.
For example, Aetna insurance considers the surgery medically necessary in a small number of circumstances. The surgery might be covered by your policy if you are having it performed to fix a deformity in the nose related to a cleft palate that you were born with. The insurance company will also potentially cover rhinoplasty performed to correct an obstruction of the nasal airway.
The company has a long list of criteria that your nose needs to meet for the surgery to be covered by a policy. For example, you’ll need to receive a physical examination that confirms that you have obstruction in the nose. You also need to have a history of nasal breathing obstruction, symptoms related to the obstruction such as trouble breathing or rhinosinusitis. Aetna also requires photographs of the nose that show the deformity, as well as a CT scan or other type of imaging that shows an obstruction in one or both nostrils.
To qualify for insurance coverage for a septorhinoplasty, your insurance provider might also ask for proof that you’ve undergone a more conservative type of treatment before the surgery, and that your problems didn’t respond to the initial treatment.
In some cases, an insurance policy might also cover rhinoplasty that is performed to repair an injury to the nose caused by a trauma, such as a car accident. Typically, the surgery needs to be performed within a certain amount of time after the accident or incident for an insurance company to cover it. Some policies also cover rhinoplasty to repair any nasal deformities that occur after a tumor, abscess, or other growth is removed from the nose.
Septoplasty
Septoplasty is performed to repair a deviation or deformity in the septum, the barrier between the nostrils. When a patient undergoes septoplasty, it’s typically because the deviation is great enough to cause significant breathing problems. When performed at the same time as the rhinoplasty, the surgery is called septorhinoplasty.
Although it’s considered a reconstructive surgery, septoplasty isn’t necessarily always covered by insurance. Some providers have strict rules when it comes to reasons they will or won’t cover the surgery. For example, your insurance provider might offer coverage if the septoplasty is performed as part of a procedure to fix a cleft palate, if it’s performed to fix an obstructed airway that doesn’t respond to other treatment, and if it’s performed to correct sinusitis that doesn’t respond to antibiotics or another form of treatment.
Pre-Approval
It’s typically recommended that you receive pre-authorization from your insurance company if you are receiving a rhinoplasty or septoplasty for medical reasons. The insurance company reviews documentation you send to it and makes the decision as to whether or not it will cover the procedure before the surgery.
Documentation you’ll most likely need to present to your insurance company includes descriptions of your symptoms, as well as a description of the results from a more conservative treatment. You’ll also most likely be asked to send in photos of your nose, taken from a number of different angles, as well as any results from imaging. Most insurance companies will want a medical history, including a record of the injury, if relevant.
If your insurance company doesn’t cover your rhinoplasty surgery, and you decide that you would like to go through with it, it’s important to under the costs upfront. Costs for the procedure include not only the surgeon’s fees, but also the cost of anesthesia, medical tests, and facility fees.
Dr. Jeffrey Epstein, who was recently named a Top Doctor in America for the 5th year in a row, will discuss any concerns you have about costs, and the procedure itself, with you during an initial consultation. Very few of the surgeries he performs are covered by insurance, as he is considered a cosmetic rhinoplasty specialist. Fortunately, his associate Dr. Anthony Bared, does work with insurance companies. If your insurance won’t pay for the surgery, you can still undergo rhinoplasty to get the nose you want. Schedule an appointment at his office in either Miami today. Call (305) 666-5884 in Miami.
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