Will Insurance Cover A Rhinoplasty When My Septoplasty Is Done?
Q: I have a deviated septum. I am pretty sure my insurance covers surgery to fix a deviated septum. I was wondering whether would there be anyway of sliding in a rhinoplasty while fixing the deviated septum to cover majority of the costs. How would that work, thanks so much.
A: The premise of your question is…can I get insurance to pay for part or all of a cosmetic procedure? While the answer to that seems obvious, it is actually an understandable and common question that has historic precedence. In the past, many cosmetic procedures were done at the same time as medical or insurance-covered procedures…and the patient was never charged for the associated expenses of operating room charges and the anesthesiologist’s time. They were just ‘rolled into’ and considered part of what was billed to insurance. The hospital or surgery center never really knew or just looked the other way.
But such surgical behavior is now long gone and is viewed for exactly what it is…insurance fraud. Getting the insurance company to pay for part of a cosmetic procedure, just because a medical procedure is being done, is not what any patient’s health insurance is intended to cover. Nor are they obligated to do so. And the insurance companies understandably take a very dim view of such actions. As a result of such past behaviors, health insurance companies have gotten very vigilant of such behavior as well as hospitals and surgery centers. There are substantial fines and even criminal sanctions if such actions are discovered on the providing facility. Therefore, any operating facility is fully aware of whether a cosmetic procedure is going to be done and expects to be paid in advance for the time involved in performing the cosmetic part of the operation.
Similarly, expecting or asking your treating plastic surgeon to make an operation appears as if it were medically necessary, when it isn’t, is just a different form of fraud. Septoplasty, or internal nasal surgery, provides functional breathing benefits and is medically necessary. A rhinoplasty, unless done as a result of a birth defect (e.g., cleft lip and palate), accident, or as a result of tumor removal, is a cosmetic change that is not eligible for medical coverage.
Dr. Barry Eppley
A detailed description and pictures of your concerns allows for the most informed response.