Will Insurance Pay for a Rhinoplasty?
Many people considering rhinoplasty are concerned about whether the cost of the treatment will be covered by their insurance. In fact, one of the most often asked questions at The Ear, Nose, Throat, and Plastic Surgery Associates during a patient’s initial appointment is “Will insurance pay for a rhinoplasty?”
The response? It depends on the kind of rhinoplasty, I suppose.
While a functional rhinoplasty is normally focused on shaping the inside pathways of the nose, usually to help improve breathing, cosmetic rhinoplasty is commonly referred to as such when the major goal of the procedure is to shape the appearance of the nose.
Many patients see Jeffrey J. Lehman, M.D., F.A.C.S., an otolaryngologist with training in facial plastic surgery, not only to address respiratory problems but also cosmetic issues they’d like to address concurrently.
Certainly, both issues can be addressed simultaneously. Is this something that my insurance is going to cover? is usually the next question. and it’s always a matter of degree, and that determination is always made through back-and-forth with insurance plans, as well as occasionally appeals,” he says.
In many circumstances, the insurance provider will cover the rhinoplasty as a functional treatment under the patient’s plan if the deviation or deformity of the nasal framework is considerable and causes airflow restriction.
According to Dr. Lehman, “in some cases, the insurance companies will say no, this is just not a covered operation, or they’ll say the situation isn’t severe enough to be classified as functional.”
If a patient’s insurance won’t pay for the operation, they can still have it done, but the rhinoplasty would be considered cosmetic.
In these cases, Dr. Lehman says, “we bill the exterior work separately as a cosmetic treatment to be paid out of cash, and we bill the functional element of the rhinoplasty under insurance.”
One of the first things you must decide if you are thinking about getting a rhinoplasty (nose operation) is how you will pay for the treatment. Medical insurance may occasionally pay in full or in part for procedures like septoplasty and/or turbinectomy, which are frequently paired with rhinoplasty. Dr. Ashkan Ghavami, a famous Beverly Hills rhinoplasty surgeon, decided to address the subject in this blog post because insurance coverage is a subject that commonly comes up during his rhinoplasty consultations.
The Insurance Industry Does Not Cover Cosmetic Rhinoplasty
Medical insurance does not generally cover cosmetic surgery operations. However, if a procedure is deemed medically necessary, it may be partially or completely reimbursed by health insurance. A rhinoplasty that alters the size or shape of the nose is regarded as a cosmetic treatment and cannot be paid for by health insurance.
Insurance May Pay Partially or Fully for Septoplasty and Turbinectomy Procedures
A deviated septum can be fixed by a procedure called septoplasty. Another procedure to repair the turbinates in the nose to relieve breathing difficulties is called a turbinectomy.
Usually, these procedures are only suggested after more conservative measures have failed to resolve the problem. These methods are only appropriate for people who:
- were born with a nose that was too small or a deviated septum
- Have chronic allergies that have caused the turbinates, a portion of the inner nasal structure, to grow and partially restrict the airway,
- Have nasal damage as a result of an accident or sports injury
- possess structural or respiratory issues as a result of a side effect from a prior rhinoplasty treatment.
In order to address both cosmetic and functional issues at the same time, some patients have rhinoplasty procedures combined with septoplasty and/or turbinectomy. Insurance will only pay for the septoplasty and/or turbinectomy portion of the operation in certain circumstances. Get a breakdown of the costs associated with your surgery so you can determine which costs are covered by your insurance.
It’s significant to note that Dr. Ghavami’s Beverly Hills clinic is not a physician contracted with any medical insurance and is not an in-network provider. However, certain PPO policies will pay for surgical procedures like turbinectomy and septoplasty that are deemed medically essential. The specifics of your individual plan will determine the scope of coverage.
Patients who require financial assistance can do so through accessible funding. The two top healthcare financing providers, CareCredit and Alphaeon, that Dr. Ghavami is happy to offer to allow patients to make affordable monthly payments based on each patient’s budget are CareCredit and Alphaeon.
Make an appointment for a private consultation with Dr. Ghavami to find out more about rhinoplasty. Call (310) 275-1959 to make an appointment with Dr. Ghavami, or send an email to our office right away.
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