When Is Rhinoplasty Covered By Insurance?

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Having rhinoplasty surgery can be a big cost with many fees incurred. However there are a few instances when insurance will pick up a portion of the rhinoplasty costs. Most plastic surgery is considered done for cosmetic reasons and therefore your insurance will not cover any of the rhinoplasty procedure if you are merely hoping to gain a better-looking nose. Most insurance companies will however what they deem medically necessary.

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Rhinoplasty as a Medical Necessity

Only your physician or surgeon can submit to the insurance company the reasons why you are having rhinoplasty surgery. As mentioned before, those procedures which are not deemed necessary by your insurance company will not be covered. If your physician feels that your rhinoplasty procedure is necessary to improve your health or quality of life they can file the forms required to in order for the insurance company to allow the surgery.

For instance, your insurance will not allow your claim if your primary reason for surgery is improving a nose that is unattractive, too large or crooked. These are considered cosmetic reasons. That is not to say that the rhinoplasty to correct the crooked nose won't ever be covered. If the main goal of the surgery is to reconstruct the nose from a trauma or developmental abnormality, then it is possible that your insurance company will cover some of the cost. This is most commonly referred to reconstructive surgery and some rhinoplasty procedures are covered when they are considered not merely to improve appearance but to reconstruct a necessary problem. If you are seeking rhinoplasty surgery, there will be prior authorizations and a review period, which must be completed before you can continue.

Rhinoplasty for Severe Medical Problems

Your insurance will not only cover for some reconstructive issues but they may also cover rhinoplasty surgery in which there is a severe medical condition or congenital defect which threatens the patient's ability to normally function. The most common occurrence of this is those people that suffer from migraines and breathing problems. A deviated septum is a possible cause but other factors such as a misshapen nose can also cause extreme pain and headaches. In some cases the breathing problems associated can be partially attributed to or complicate sleep apnea and the overall function of the nostrils. Check with your insurance provider to find out exactly which types of procedures are covered and to what extent.

Denial of Coverage and What to Do

If you are denied coverage and your surgeon and you believe your procedure is medically necessary, you can begin an appeals process. A thorough look through your policy is the first step in appealing the insurance company's decision to pay none or only a small percentage of the rhinoplasty surgery. Next you will want to write a letter to the claims supervisor stating your case and why you believe this procedure should be covered. Don't be surprised if you have to supply them with test results, X-rays and other testing to help prove your case.

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