Insurance Coverage for Rhinoplasty

When considering cosmetic surgery, cost is often a concern for patients. They may wonder whether their procedure might be covered by insurance. In some cases, a plastic surgery procedure might be covered by insurance, but often is not. In rhinoplasty, things such as correcting a breathing problem will probably be covered, while changing the visual appearance of your nose will not. Simply put, ask yourself whether your procedure is medically necessary: if it is, insurance will likely pay; if not, they will not.

Many types of medically necessary nasal surgery can be covered by insurance. Septoplasty surgery to correct a deviated septum, for example, when the crooked septum is causing breathing problems, will generally be covered by insurance. There are many other nasal surgeries that correct obstructions and other issues related to respiration that will also be paid for by insurance. Most of the time, these procedures will not change the outward appearance of the nose.

Typically, cosmetic procedures designed to change the appearance, not the function, of the nose are not covered by insurance. Health insurance exists to cover health-related expenses, and as such a rhinoplasty procedure intended to change the shape of the nose does not meet the criteria.

However, there are a few cases in which a cosmetic procedure may be covered. For children born with some birth defects such as a cleft palate, procedures that do change the appearance of the nose will be covered. These are often called reconstructive surgeries. Reconstructive surgery will generally also qualify for coverage in the case of a broken nose or tumor removal. This does not mean that a cosmetic surgery for an old break will qualify; generally it needs to be a recent injury.

It is important to remember that even if you are having a medically necessary procedure such as a septoplasty, your surgeon cannot also give you a rhinoplasty and roll it into the insurance charges. This practice, or other similar methods of skirting the rules, are insurance fraud and are illegal. Instead, the surgeon must charge you separately for the rhinoplasty portion of the procedure. Additionally, all insurance policies are different, and it is important that you understand yours and what procedures will and will not be covered.

If you are interested in rhinoplasty for yourself, contact Bay Area plastic surgeon Dr. Kabaker at 800-914-4247 to set up a consultation.

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