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.
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:
Nose surgery that is NOT covered:
It is possible to have a cosmetic procedure done when undergoing functional nose surgery. However only the costs associated with the functional portion of the procedure would be covered by health insurance. If, during surgery, the nose is reshaped for purely aesthetic reasons, the patient would have to assume the financial responsibility for that portion of the procedure. This means, the patient would have to pay for ALL fees incurred that relate to the cosmetic rhinoplasty, as well as any and all deductibles, co-insurance, and co-pays that arise from the functional nose surgery.
At Profiles Beverly Hills in Los Angeles, we regularly perform cosmetic rhinoplasty, as well as functional surgery, specifically septoplasty. We understand that navigating health care coverage can be a challenge. We will do all we can to ensure that you understand the financial implications of any diagnosis that warrants or recommends nose surgery. If you are considering nose surgery, visit our L.A. practice for a consultation!
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