Health Insurance May Help Cover Costs Associated with Rhinoplasty Surgery

Here are the top best Is rhinoplasty covered by insurance public topics compiled and compiled by our team

For those considering rhinoplasty to improve their appearance, it’s important to understand how/when health insurance can be used to help cover the cost of surgery.

Orange County rhinoplasty surgeon, Dr. Joseph T. Cruise, is one of the top nose specialists in the country. He has performed hundreds of nose surgeries throughout his career, not only for aesthetic reasons, but also to correct airway obstruction issues. This experience has enabled Joseph T Cruise, MD and his staff to become very familiar with health insurance pertaining to nose surgery.

Patients seeking treatment for breathing issues are often times able to use their health insurance benefits to assist with the cost of surgery. Most of Joseph T Cruise, MD’s Orange County rhinoplasty patients see him for cosmetic concerns, however during his evaluation, he frequently comes across patients who have a breathing obstruction without even knowing it. For this reason, he evaluates all of his rhinoplasty patients to determine if airway issues are present. Joseph T Cruise, MD explains he frequently finds a person has been so focused on how much he/she dislikes the way their nose looks, they have no idea they have underlying issues with their breathing. If a patient has health insurance, they are even more surprised to learn a portion of their surgery may be covered . If there are functional and cosmetic issues, it only makes sense to have them corrected at the same time. Not only does this avoid the additional risk and downtime of a second surgery, it also increases the probability of a successful outcome since the form and function of the nose are intertwined.

Health insurance companies typically provide benefits for breathing issues and trauma to the nose. Difficulty breathing is often times associated with deviated septum and/or turbinate hypertrophy. Trauma (past or present) to the nasal area leading to nasal fractures is usually covered. Either problem mentioned above can be corrected at the same time as rhinoplasty surgery. In general, health insurance will not reimburse for a cosmetic procedure such as rhinoplasty, which is strictly for aesthetic improvement. There must be an underlying problem deemed to be a medical necessity before they will consider the claim. Since insurance plans vary, Joseph T Cruise, MD asks his patients to call them directly to get specific benefit information. Insurance companies will need the ICD-9 and CPT codes to determine if the patient’s diagnosis and treatment are covered under their plan, as well as what to expect in terms of a reimbursement amount. Joseph T Cruise, MD and his staff provide patients with the information they need prior to inquiring with their insurance company.

A few other important things to know –

  • When having surgery with a plastic surgeon it is common practice to pay their fees prior to surgery. Any reimbursed amount from insurance will go back to the patient, but only equaling to the amount originally paid, nothing more.
  • Many outpatient surgical facilities and anesthesiologists may collect just a portion of the fees (i.e. deductible) upfront, with the reimbursement from insurance going directly to them, not the patient.
  • Insurance coverage is never a guarantee. Even if all requirements of the insurance company have been met by the patient, plastic surgeon and/or their health insurance processor, they can still deny a claim. Denied claims can be appealed, but there is still no guarantee of reimbursement.
  • It is important to go to a qualified rhinoplasty surgeon who has experience dealing with insurance cases. The plastic surgeon plays an integral role in the claim being accepted, because insurance companies require documentation of the diagnosis, operating notes, pictures, etc. If the requirements are not met by the surgeon, the claim will likely be denied.

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