Dr. Shervin Naderi (double-board-certified facial plastic surgeon, rhinoplasty specialist) explains whether insurance will pay for septoplasty or rhinoplasty. He distinguishes functional procedures (e.g., septoplasty for airway obstruction) that insurers may cover from cosmetic changes (tip refinement, hump removal, narrowing) that are typically out-of-pocket. He describes common billing practice (insurance billed for the functional portion, cosmetic portion billed separately), cautions against misrepresenting procedures to obtain coverage, and urges patients to verify benefits, document communications, and check deductibles.
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Hi, My name is Dr. Shervin Nadiri. I'm a double board certified facial plastic surgeon and I'm a rhinoplasty specialist. Basically, 100% of my surgical practice is dedicated practically to rhinoplasty. Now, one of the questions that always comes up my patients is, does insurance cover a rhinoplasty or part of a rhinoplasty? And the answer is complicated. Insurances have changed over the last several years. In the last few decades, it's really been a work in progress and it depends on each individual patient's insurance. Blue Cross, Aetna, Cigna United, they have different policies. Just because you have Blue Cross doesn't mean it's the same policy from person to person. Essentially, insurance companies can or possibly will cover functional issues. For example, if somebody comes in with a crooked septum that's causing airway obstruction, a deviated septum, that part hopefully should be covered by insurance. There's no guarantee, but hopefully should be covered by insurance. Cosmetic changes, making the tip smaller, making the tip less droopy, bringing down the bump on the nose, making the nose narrower. Those are cosmetic changes, even making a nose straighter. And insurance companies will not cover that almost all the time. There have been some exceptions, but most of the time they don't cover that. And that's an out of pocket expense. Typically, if both things are involved and the septum is deviated and it's causing obstruction of the airway and the nose needs to be made prettier or a better, more refined nose, what happens is we bill a portion of it through insurance and the rest of it is cosmetic. Now, the portion built through insurance is a small portion. It's not a significant portion in any rhinoplasty surgeon's practice, but it's something that covers some of the anesthesia fees, some of the hospital fees, and it's completely kept separate from the cosmetic portion. The surgical time, the record keeping, the operative notes, they're completely separate. They really don't cover each other. Unfortunately, there have been some surgeons that will, for lack of better terms, make a surgery come across as something else to have insurance cover a portion of the surgery or maybe all the surgery, but frankly, that's not advisable. I hate using the word insurance fraud, but essentially that's what that is, and we don't do that. So if there is a part that needs to be covered by insurance, then we contact insurance companies, check the patient's benefits, make sure that the deductibles are not too high, because we don't want our patients getting stuck with a very large bill afterwards. Alternatively, a lot of the surgery centers and hospitals will have significantly reduced cosmetic fees for the facility and the anesthesiologist fee. And if the patient doesn't have insurance, then they can cover the entire surgery out of pocket at a very reduced cost. So if a patient has good insurance and has actual needs for functional surgery, then they can use their insurance. If they don't have insurance, if they don't have good coverage or poor coverage, they and they can just pay out of pocket for the entire thing. Sometimes the septum needs to be straightened for cosmetic reasons. It may be causing crookedness of the nose, not really airway obstruction. That situation, again has nothing to do with insurance and it's purely a cosmetic issue out of pocket. I hope this helps clarify the question whether insurance companies will cover septoplasty or rhinoplasty. But the best answer is you got to check with your own individual insurance company and documented write down who you spoke with when you spoke with them. Because I have seen situations where an insurance will say they cover it and then afterwards deny coverage. You want to really protect yourself and make sure you don't end up with a large bill afterwards sent to you by the hospital or the surgery center. Check with your doctor. Thank you very much.
