Will Insurance Pay for Both a Deviated Septum and a Rhinoplasty?

I know that insurance companies are not that eager to pay for cosmetic procedures but what if I have a crooked nose and a deviated septum due to an accident I had a year ago? I can live with it but I would rather get it fixed if insurance will cover it. I imagine it’s probably impossible to have a cosmetic procedure covered, but I would be glad if my insurance at least paid for correcting my deviated septum. Any thoughts on this?

marisseytl

F, 33, Vermont

Trying to figure out what your insurance will and will not cover can be such a hassle! I spent weeks trying to have this question answered and it seriously took all of my energy to keep from screaming whenever I spoke to my insurance. Eventually, they finally gave me some clear answers but it was such a maze to figure out. 

My insurance covered my deviated septum because that is a medical issue but they wouldn't help me fix my crooked nose. That was something that I had to pay for out of pocket completely; however, what ResidentDoc said is completely true. It is far cheaper to take care of both of the problems at the same time because it cuts down on the extra costs that are associated with surgery. 

In short, I bet your insurance will pay for the deviated septum but leave you with the cost of repairing your crooked nose. You should try to schedule the procedures at the same time and expect to pay for most of one procedure out of pocket. Also, talk with your doctor to see if they can code anything differently so that your insurance will cover more of the costs for you.

In the vast majority of cases, health insurance plans offer coverage for health issues of a functional nature. A deviated septum often qualifies as a functional issue, since one of the nasal passages is partly or fully blocked by the nasal septum.

Insurance will cover septoplasty if the nasal obstruction is causing breathing problems, or contributing to sinus infections. In some cases, the nasal fracture may also be included in coverage, particularly if the injury is due to an accident which happened fairly recently as in your case.

Septoplasty will not markedly change the appearance of your nose. If your nose is severely crooked, and the crookedness is in part due to septal trauma, then straightening the septum will also straighten the nose to some degree, improving its cosmetic appearance. If the deviated portions of the septum are more internal,  cosmetic improvement of the nose will not be so apparent.

Insurance companies are very thorough in assessing cases for functional rhinoplasty. They will often require you to present documented evidence from your doctor and imaging such as a CT scan, to confirm that the extent of the deviation is affecting the quality of your life.

If your insurance carrier agrees to cover the cost of your septoplasty, there are advantages to having cosmetic rhinoplasty performed at the same time, though you will need to fund it out of your own pocket. The cost of the rhinoplasty will likely be reduced as the insurance company covers a significant portion of the surgical center fees and the cost of the general anesthesia, if applicable.

Find an experienced board-certified facial plastic surgeon who can help you determine whether you are a good candidate for septorhinoplasty. Having both procedures performed at the same time means you can address breathing difficulty and improve the appearance of your nose simultaneously, with a reduced recovery time from avoiding undergoing the procedures separately.

Dr. Alexander Ovchinsky has 10 Revision Rhinoplasty before & afters:

Revision Rhinoplasty before image performed by Dr. Alexander OvchinskyRevision Rhinoplasty after image performed by Dr. Alexander OvchinskyRevision Rhinoplasty before image performed by Dr. Alexander OvchinskyRevision Rhinoplasty after image performed by Dr. Alexander OvchinskyRevision Rhinoplasty before image performed by Dr. Alexander OvchinskyRevision Rhinoplasty after image performed by Dr. Alexander OvchinskyRhinoplasty (nose job) before image performed by Dr. Alexander OvchinskyRhinoplasty (nose job) after image performed by Dr. Alexander Ovchinsky

» View Dr. Alexander Ovchinsky's full profile

You are correct - insurance companies will not usually pay for cosmetic procedures. Insurance will typically only cover the functional part of your operation. This means the repair of your deviated septum should be covered by insurance but they will not likely cover fixing your 'crooked nose.' However, it is still cheaper to have your deviated septum and 'crooked nose' repaired at the same time. This is because a large percent of your surgeon's, anesthesiology and OR fees will be covered by insurance and since both issues can be repaired during the same surgery, the cost is significantly reduced. If you do decide to repair your nose aesthetically, I would do a lot of research on the surgeon you pick. Repairing a nose functionally and cosmetically require two sets of skill. To repair your nose aesthetically, your surgeon needs an 'artistic eye,' as a rhinoplasty can be a very complex procedure. Repairing a deviated septum does not require as much surgical skill. You should also only go to a board certified plastic surgeon or otolaryngologist (ENT/facial plastic surgeon) and make sure whatever surgeon you meet with shows you many before and after photos and has done at least 500 cases in their career. Good luck! 

 

When it comes to discovering what health insurance will and will not cover, it can be a labyrinth of confusion, exhaustion, and prior authorizations. Many insurance companies treat surgical procedures in different manners, so it can be difficult to provide an answer that is a "catch all" to this question. However, most insurance companies will pay for plastic surgery that is necessary to correct a physical trait that is causing pain or affecting a patient's quality of life. Yet, as you mentioned, if any portion of the procedure is considered "cosmetic," it can be difficult to get the insurance company to comply with payment. However, it is very rare to find an insurance company that does not cover the cost of correcting a deviated septum. It is merely the cosmetic portion of the procedure that comes into question.

If your main goal to to alleviate symptoms that are linked to your deviated septum, it is best to address this main goal with your surgeon first and foremost. Most insurance companies analyze the process carefully to ensure they are not paying for any portion of the procedure that is related to the cosmetic enhancement. Otherwise, most insurance companies will pay for the portion of the procedure that is associated with the health issue. Any costs that are incurred from the cosmetic enhancement, including anesthesia, surgeon fees, and operating facility fees will be passed on to the patient.

That's a toughy. Some insurance companies will cover both, some will only cover the necessary part, and some won't cover either. I'd say you should call your insurance company and find out what they cover and what sort of documentation they might need. Since you were in an accident, you should be able to get a decent amount of documentation proving that it happened in an accident. But even then, if it isn't "bad" enough, they may not think it's important to cover it. I wish you good luck!

Yes. I agree. Insurance companies don't pay for cosmetic procedures as they consider it as a non-essential procedure. I had undergone a cosmetic rhinoplasty procedure in Toronto about a year ago and my insurance company refused to pay up the bill. They said if it was broken nose correction surgery or a surgery which is performed to correct breathing trouble, they are ready to pay. I have read a blog which explains about it in detail. Hope this would help you. 

http://www.rhinoplasty.ca/2016/04/25/will-my-insurance-cover-revision-rhinoplasty/