Insurance coverage of rhinoplasty
Essentially the answer comes down to the question if your rhinoplasty is functional or cosmetic. IF it is the former, then there is a greater likelihood that the procedure will be covered. If it is cosmetic, it is highly improbable that it will be a covered procedure. (Otto Joseph Placik, MD, Chicago Plastic Surgeon)
Medical insurance won’t cover cosmetic surgery
Many people have tried! But it doesn’t work. Here in Canada, our provincial medical coverage will pay for damaged noses, either from injury, prior surgery or developmental reasons. If you have difficulty breathing, and it’s due to a surgically correctable cause like a deviated septum, the cost will be covered. Likewise if you have broken your nose and the external appearance is crooked.
But that’s where it ends. Anything else is cosmetic and is the responsibility of the patient. A nose with a dorsal hump won’t have a straight profile afterwards. People are often surprised that a crooked nose won’t necessarily appear straight after corrective surgery to improve nasal breathing.
The reason is the surgery needed is internal, and often the septal straightening isn’t reflected externally. The problem area is at the bottom of your nose, not the bridge between the eyes.
However not all is lost! Combining functional and cosmetic nasal surgery can reduce the overall cost somewhat, as a part of the institutional/surgicenter costs, those directly related to the functional work, are picked up by the provincial carrier. (Oakley Smith, MD, Toronto Facial Plastic Surgeon)
Rhinoplasty insurance coverage
We need to define terms in order to educate you on insurance cover/benefit vs cosmetic/non covered benefit surgeries. Also as the previous experts have stated there is a very fine line in committing fraud.
So be very clear as to what you are asking for. Now Cosmetic rhinoplasty is an operation to change the external appearance of the nose. There are no functional deformities or diseases associated with these operations. Thus, no insurance benefits are available.
If you are trying to get $’s from the insurance company because your feel paying the monthly premiums should apply, then help change the laws and the possible penalties to the patient and doctor. Now the term reconstructive rhinoplasty, Internal Septoplasty, Open or Closed reduction of nasal fractures, Turbinectomy are all deformities or disease associated issues with the nose that are insurance covered benefits.
If you have these real issues with documentation as to history and length of time having these issues than there could be insurance coverage. Please discuss and be examined by boarded surgeons. Be careful out there, if the surgeon will lie for you to get you insurance $’s than if the surgery has a problem it is obvious the surgeon has no ehtics but to lie to you. (Darryl J. Blinski, MD, Miami Plastic Surgeon)
Rhinoplasty and insurance
Rhinoplasty is not covered by insurance. It is a cosmetic procedure. If you have a severe septal deflection and airway obstruction, the septal work may be covered. (Steven Wallach, MD, Manhattan Plastic Surgeon)
Rhinoplasty is not an insurable procedure
Because there is no “medical necessity” to have a pretty nose, there is no insurance that would cover a rhinoplasty. In my opinion, with necessary medical care often grossly under compensated by insurance, they shouldn’t be involved in spending money on cosmetic surgery either. (Richard P. Rand, MD, FACS, Seattle Plastic Surgeon)
“Getting” Insurance to pay for a Nose Job (Rhinoplasty)
There is no way you can cajole, coerce, influence, sway, impel or persuade an insurance company to pay for Cosmetic Surgery (such as a Nose Job) OR for any surgery which was not agreed upon in your contract. Lying to an insurance company is a felony and very few doctors will do it. (Peter A. Aldea, MD, Memphis Plastic Surgeon)
African American Rhinoplasty
If you have a medical problem with your nose such as a deviated septum, nasal fracture or some other disorder causing breathing problems related to your nose, insurance can sometimes cover these issues. The cost of the cosmetic part is usually then reduced. This varies from state to state and from doctor to doctor. (Oleh Slupchynskyj, MD, FACS, New York Facial Plastic Surgeon)
No insurance coverage for a cosmetic rhinoplasty
Insurance companies will only cover those surgical procedures that are considered reconstructive. This will generally cover problems with air way obstruction such as a deviated septum or deformities related to a nasal fracture. No insurance company will cover a purely cosmetic rhinoplasty. (Jeffrey Zwiren, MD, Atlanta Plastic Surgeon)
Insurance Coverage for Rhinoplasty only in very select instances
The standard of medical necessity must be met if a rhinoplasty is to be covered by your insurance company. That being said, insurance companies have different criteria by which they will judge whether this standard is being met.
A cosmetic rhinoplasty is never covered by insurance and an ethical surgeon would never try to submit this to insurance. Only in the following select cases, could a rhinoplasty be considered medically necessary:
- Severe nasal trauma with obvious external and internal nasal deformity. Photos after the trauma illustrating the deformities must be submitted, and these deformities must be described by your surgeon in his examination. If deemed medically necessary, there are insurance codes that your doctor can use for a “reconstructive rhinoplasty” to put your nose back to the way it was before the accident.
- Severe nasal obstruction requiring open nasal valve reconstruction is essentially a “functional rhinoplasty” to improve breathing. You must have failed medical therapies aimed at improving breathing, and often such patients have already failed to breathe better after septoplasty and turbinate reduction. Sometimes, patients are referred to me because they have previously had a cosmetic rhinoplasty, and now find that they breathe poorly due to nasal valve narrowing Strictly speaking, there are no codes for a functional rhinplasty to treat airway obstruction, but rather nasal valve codes are used.
- Cleft rhinoplasty is the last type of rhinoplasty that is commonly performed under the auspices of insurance. All children with a cleft lip have an associated cleft nasal deformity that may require surgery in their teens. This is a reconstructive rhinoplasty to alleviate the cleft nasal deformity. It is not cosmetic. (Randolph Capone, MD, Baltimore Facial Plastic Surgeon)