Functional rhinoplasty or septoplasty, the surgery designed to correct documented breathing problems, may be covered by your health insurance. This is one of the few plastic surgery procedures we can say that about: there is a chance your insurance will cover your procedure, at least in part. Technically, functional rhinoplasty is not cosmetic surgery, since it’s done to correct breathing issues that may be due to a deviated septum or other physical problems with your nose.
Functional rhinoplasty need not always make visible changes in the look of your nose, but the nasal contours can be changed to a more appealing form if you like. Discuss your goals for surgery with an experienced plastic surgeon, preferably one with reconstructive experience. This will help ensure you get a terrific result, improving both your breathing and your nasal shape.
Who Needs Functional Rhinoplasty?
Candidates for functional rhinoplasty (to repair the inner structures of the nose and create free airflow) include patients who:
- Were born with a deviated septum or excessively narrow nose
- Have longstanding allergies that have caused part of the inner nasal anatomy (the turbinates) to enlarge, partially blocking the airway
- Nasal trauma from an accident or sports injury
- Prior unsuccessful rhinoplasty causing collapsed nostrils or other functional defects
Why Plastic Surgeons Excel at Functional Rhinoplasty
Even if you don’t want your nose to look different after functional rhinoplasty, and merely want to preserve the aesthetic appearance of your nose while breathing is improved, be sure to select an experienced and highly trained plastic surgeon. A plastic surgeon will work to preserve the look you like while also improving your breathing.
In certain cases, it may be necessary to slightly change the width or appearance of your nose; in order to repair collapsed nasal vaults with grafts, for example. A plastic surgeon is an ideal choice to ensure you look just as great after the procedure as you did before–and breathe much better.
Can Health Insurance Cover Functional Rhinoplasty?
There is no one set of instructions that will tell you, for certain, how to get your insurance to cover functional rhinoplasty procedure. However, there are some tips that you should keep in mind, which are common to many insurers. The basic rule of thumb is: follow your insurance company’s rules carefully; about documentation, pre-authorization and sometimes second opinion. When you carefully adhere to your specific insurance company’s rules, you’re more likely to have them consider paying for your rhinoplasty. Here’s how to prepare:
- Read up on the details of your health insurance policy. Many use wording similar to “we cover surgeries that are medically necessary.” If your company states this, the insurance handbook or documents should go on to say what the parameters are to demonstrate medical necessity.
- Consider calling for clarification. If your insurance company’s rules are not clear in your handbook or on their website, you might want to call and get clear instructions. Keep in mind, however, that some insurance companies will only give determinations in writing. They may use a disclaimer that says that information given on the phone is not a guarantee of coverage.
- Collect required documentation. If you have breathing problems related to a deviated septum or other functional problem with your nasal structure, collect the documentation that your insurance company has requested. You may need to get information from your family physician sent to your insurance company, as well as a written opinion from your plastic surgeon.
- Choose a plastic surgeon who is patient enough to work with insurance companies. The plastic surgeon and his staff will have to spend a bit of time putting together the documents required by your health insurance. Some plastic surgeons won’t take the time to do this—however, some of the best plastic surgeons and their support staff will be happy to provide information about your case to your health insurance company with your permission. Records your insurance company might request, in order to make a coverage determination about functional rhinoplasty:
- X-rays
- Other test results
- Statements of medical necessity from your primary physician/general practitioner.
- Failed treatments: Most insurers will also want to know what other treatments, short of surgery, have been tried to improve your breathing. Sometimes a health insurance company won’t cover surgery until other treatments have been given a chance (over a set period of time) to help your breathing problems. These requests may seem daunting, but it’s important you follow all your insurer’s rules in order to obtain coverage.
- Or other types of documentation and medical records
- Find out if you need a second opinion. If so, ask if you need to see a particular plastic surgeon for this.
- Check to see if you must use a particular plastic surgeon for functional rhinoplasty. Your insurance company may require that you use an in-network surgeon, in order to gain coverage for septoplasty or functional rhinoplasty. Many companies will cover out of network surgeons to a lesser degree.
What if You Want Aesthetic Changes along with Functional Rhinoplasty?
As mentioned, correcting your breathing problems by repairing your nasal septum or making other function-related, internal, changes to your nose may not result in changes you can see from the outside. If you want your nose to look different after functional rhinoplasty, you and your surgeon must discuss this at your consultation, when planning your rhinoplasty. Visible nasal reshaping (if it’s non-reconstructive) falls into the category of cosmetic plastic surgery—and is typically not considered medically necessary.
- Learn about insurance coverage for a combined rhinoplasty procedure. Check your insurer’s coverage documents or call the company to determine whether your insurance company will pay for the functional part of your nasal surgery if it is done at the same time as the aesthetic nose job.
- Find out costs for each portion of the surgery. Ask your surgeon how much the surgeon’s fee, anesthesia cost, anesthesiologist’s fee and surgery center hourly costs will be for that portion of the procedure.
- Insurance company payment scenarios: If your insurance carrier agrees to pay for a share of the functional portion of your rhinoplasty surgery, they have a variety of ways to allocate the costs. These details are known only to the company, but a number of different formulas have been used. Ask the insurer how costs will be divided between functional and cosmetic. Hypothetical examples:
- As an example, your insurance company might pay for your general anesthesia, or they may insist that the cost is divided between the functional and cosmetic portions of the surgery.
- Depending upon how your insurance company interprets the bills for your rhinoplasty (often after the fact), the company could just divide anesthesia costs in half—then cover part of the functional half, according to their rules about co-pays, deductibles and surgical cost sharing.
- As another example, insurers might allocate costs according to surgery center time needed for each part of your surgery.
- Or the company may have another way of apportioning the costs that apply to both functional and cosmetic aspects of your nose job. Although your insurance company should give you this information before surgery, in reality, they may try to leave details to be handled once they receive bills. You may have to be persistent to get detailed, reliable information in advance.
- Find out if your plastic surgeon requires full payment up front. Some plastic surgeons don’t accept insurance. They may obtain full payment prior to surgery from you -and then you would later submit bills to your insurance company for partial reimbursement.
Other Financial Options for Rhinoplasty
If you cannot obtain coverage through your health insurance, or are concerned about managing costs for your portion of the payment, you could consider the following potential options:
- Credit card payment for plastic surgery: If you have a card with a relatively reasonable interest rate, this could be an option for your rhinoplasty costs. Some plastic surgeons accept credit cards specifically marketed/intended for medical or cosmetic health/dental care.
- FSA (Flexible Spending Accounts): You may have a plan through your employer or business, and may be allowed to use this pre-tax savings account to pay some or all of your costs for functional rhinoplasty. Check with your plan administrator about rules for your plan.
- HSA (Health Savings Account): These savings accounts are part of certain high-deductible health insurance plans or catastrophic coverage plans. Plan participants use their pre-tax health savings account to pay for medical care until they reach their high deductible. Medically necessary portions of your surgery may qualify. Check with your plan administrator about rules.
Functional Rhinoplasty Benefits
Functional rhinoplasty helps you to breathe better and enjoy life more. You may also look better, with a more symmetric nose and/or refined profile, (if for instance, functional rhinoplasty repairs a collapsed airway on one side or a broken nose that never healed properly.) Untreated, nasal obstruction can limit your life. Functional rhinoplasty can help eliminate:
- Congestion
- Mouth breathing
- Dry mouth
- Increased dental cavities
- Reduced sense of smell
- Recurring nosebleeds
- Social anxiety
- Chronic sinus infection
- Headaches due to sinus pressure
- Insomnia and fatigue
- Sleep apnea
- A dulled sense of hearing (due to Eustachian tube dysfunction)
- And more
Improve Your Quality of Life with Functional Rhinoplasty
Whether or not you have health insurance that will cover functional rhinoplasty, the procedure can still be extremely worthwhile. The surgery is safe and has a high satisfaction rating among patients. Choose a highly qualified plastic surgeon that you trust to perform your rhinoplasty, and you’ll enjoy the results, breathing better for the rest of your life.
