The Basics

When faced with the prospect of undergoing a medical procedure, one of the first things we ask is: Will I be covered? The answer to that question is complex and varies. Because health insurance policies differ greatly, it is important to have a comprehensive understanding of the terms of your plan when considering nose surgery.

Not only is it important to be aware of what procedures are eligible for coverage, it is equally important to know the specific payment responsibilities you may have (in the form of deductibles, co-insurance, out of pocket maximums, and copays). Finally, you should know what flexibility you have within your plan to choose your doctor. If you belong to a HMO (health management organization), the process of choosing a specialist, is different than with a PPO (preferred provider plan). With an HMO, you must be referred to a specialist through a primary care physician (PCP); with a PPO you can seek the care of a specialist directly. If the specialist you seek is within network of participating doctors in your PPO, you are covered for a greater amount of your medical treatment than if you opt to go out of network.

Please keep in mind that it is your responsibility to understand your health insurance plan and coverage. Read your policy carefully and call your insurance company with questions.

Insurance and Nose Surgery

In general, health insurance does not cover procedures that are considered cosmetic, such as the reshaping of the nose. However, conditions that impede nasal function – deviated nasal septum, nasal fractures (broken nose), nasal valve stenosis (narrowing), and enlarged or overactive turbinates, for example – are considered medical conditions and are typically covered in whole or part.

Nose surgeries that are typically covered by health insurance:

• Surgery for Deviated Nasal Septum (Septoplasty)
  A crooked, or deviated, septum (the partition between the two nasal cavities) is a common internal condition that can cause breathing problems. Although often present at birth, a deviated septum can also develop as a result of some injury or some trauma to the nose. Septal reconstruction, or septoplasty, involves straightening the septum to facilitate better nasal respiration. Septoplasty addresses nasal function and, therefore, will not result in any changes to the nose’s appearance. It is important to note that if a patient decides to have a cosmetic correction at the same time as septoplasty, the cost for the aesthetic portion of the procedure will not be covered.
• Repair of a Broken Nose
  Usually covered by health insurance, this common procedure repairs a fractured or broken nose caused by an injury. As a result of the trauma, a patient may experience external changes to the nose – such as a crooked or misaligned appearance – as well as suffer internal damage to the septum and obstructions to the nasal passage. If external and internal conditions are present, both should be addressed during surgery.

Nose surgery that is NOT covered:

• Cosmetic Procedures (Rhinoplasty)
  Rhinoplasty or revision rhinoplasty – a nose job – is a cosmetic procedure that improves the appearance of the nose. Because it does not address an underlying medical issue, health insurance will not cover the surgery.