Is a Rhinoplasty for a Deviated Septum Covered by Insurance?

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A deviated septum is a condition in which the wall that separates your two nasal passages, known as the septum, is shifted, or deviated, to one side. This deviation can obstruct the nasal passages and cause difficulty breathing. Living with a deviated septum and the associated breathing complications can be inconvenient, but there is an effective treatment option in the form of rhinoplasty for deviated septum.

Rhinoplasty is the medical term for any surgery that reshapes the nose. It’s a safe and relatively quick way to permanently fix a deviated septum. As with any surgery, however, it’s a good idea to learn about your financial obligations in advance.

Rhinoplasties that are for a specific functional purpose, like to improve breathing by fixing a deviated septum, are often covered in full by insurance companies. For a deviated septum due to a broken nose or other deformities, this procedure is commonly referred to as a “septoplasty” amongst professionals.You should note that insurance coverage can vary widely depending on the patient, the insurance company, the procedure, the healthcare provider and more. The best way to sort through the uncertainty is to speak with qualified insurance experts.

Rhinoplasty for Deviated Septum: Where Should I Start?

There is a lot of information available about different insurance plans and the procedures they cover, but it can be hard to sort through it all. For this reason, it’s important to turn to the right sources. The two most reliable sources of information about whether a rhinoplasty for a deviated septum is covered are your insurance company and insurance benefits specialists.

Insurance Company

The first step you should take to resolve any uncertainty about the extent of your insurance coverage is to speak directly with your insurance company. They should be able to explain to you what your plan does and does not cover.

Usually, the term “rhinoplasty” relates to a cosmetic procedure, which is not covered by insurance. The correct term for a rhinoplasty for a deviated septum is a “Septoplasty.” When speaking to your insurance company, be sure to use this proper term to clarify the reason you are undergoing the procedure.

Benefits Specialist

In case you would like further clarification after speaking with your insurance company, you also have the opportunity to speak with a benefits specialist. A benefits specialist is someone who is trained specifically to help patients gain a better understanding of their insurance plans and how they align with the treatments they seek. These specialists may or may not be directly part of the surgeon’s practice, but either way, you will be getting the same information.

Speaking with an insurance benefits expert is a smart way to resolve your questions and concerns before your operation so that you can focus entirely on your recovery. You may find it helpful to work with a surgeon who has a benefits specialist on-staff.

What Is In-Network vs. Out-of-Network Insurance?

One of the concepts that may come up in your discussions with your insurance company and your benefits specialist is the distinction between in-network and out-of-network insurance. This distinction has important implications for the extent of your insurance coverage for your rhinoplasty for a deviated septum.

In-Network Insurance

Every insurance company has a network of doctors, hospitals and other healthcare providers with whom they prearrange prices for your care. That is, in-network health care providers negotiate the price of a given treatment with your insurance company well in advance — and it’s usually at a discount.

Fortunately, some plastic surgeons are affiliated with insurance companies and considered to be in-network. Finding out which ones are in-network is simple and a list is usually provided on your insurance’s website.

Out-of-Network Insurance

Out-of-network health care providers have no such arrangement with your insurance company and are thus likely to be more expensive. However, these providers can sometimes negotiate with insurance companies and still offer a competitive price. Note that even if a given surgeon is not in your network, it may still be advisable to pursue or continue treatment with him or her. It depends on your insurance plan, the surgeon and the details of your case. If you feel more comfortable with an out-of-network surgeon, it may be worth the extra cost.

A common misconception about in-network surgeons who perform a rhinoplasty for a deviated septum is that they are less skilled because they are cheaper. In reality, the contracts between the surgeon and the insurance company have no correlation to the skill level of the doctor.

What Information Do I Need When Speaking to a Benefits Specialist?

If you decide to consult with a benefits specialist to discuss your insurance coverage, you should bring information about your condition and your insurance plan so that you two can have a productive discussion. The more relevant information you bring, the more efficiently you can clarify your coverage and move forward with the rhinoplasty for your deviated septum.

Relevant information includes the names of your surgeon and the practice (if the benefits specialist is not part of your surgeon’s staff), your tax identification number, the diagnosis code for your deviated septum, the CPT or insurance code for the procedure and any relevant medical records or test results. Be sure to ask your surgeon or your benefits specialist if you have any questions about how to obtain this information.

Will Insurance Cover All Aspects of the Procedure?

At the end of the day, the central insurance-related question about your rhinoplasty for a deviated septum is whether the procedure will be covered. As a patient, it’s important that you understand your financial obligations well in advance of the procedure so that you can direct your energy and attention toward a fast and smooth recovery.

Although most functional rhinoplasty procedures (such as septoplasties) will be covered by insurance, it is possible that not all aspects of the procedure will be covered. Make sure to ask about anesthesia fees, overnight fees (if you will be staying overnight) and fees for pre- and post-operative visits. Knowing what fees you will be responsible for prior to the procedure will allow you to plan ahead and eliminate the chance of surprise bills after the fact.

Health insurance can be a complicated subject to navigate, but there are trustworthy sources you can use to gain a clear understanding of your coverage. If you are considering a rhinoplasty for a deviated septum, feel free to ask as many questions as you like of both your insurance company and your benefits specialist so that you can feel more confident about your treatment.

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