If you are considering rhinoplasty and the doctor suggested septoplasty as well which insurance will most likely pay for will your insurance company cooperate?

Answer 1

Rhinoplasty may be performed for reasons which are purely cosmetic, purely reconstructive, or a combination thereof. Reconstructive or medically-necessary reasons conventionally include nasal breathing obstruction and traumatic, congenital or severe developmental deformities. Septoplasty also may be performed cosmetically, as part of internally aiding correction of an external cosmetic deformity, or as reconstructive, in order to improve nasal breathing and deformity as part of the reconstructive rhinoplasty. The determination of whether either rhinoplasty or septoplasty are cosmetic or reconstructive (medically-necessary) is made by your surgeon based upon your reported medical history, your nasal symptoms and your surgeon's documented findings upon examining your nose.

The determination of whether your insurance, or any other third party, will pay for the expenses of a proposed nasal surgery will be based upon the surgeon's documentation supporting the criteria of your covered benefits within your individual insurance agreement. Felony fraud, or conspiracy felony fraud, only applies if you, or your surgeon, should choose to intentionally misrepresent information in efforts to gain third-party payment for surgery expenses when the criteria for coverage are absent.

If you and your surgeon have accurately described and documented your reasons for proposing nasal surgery, then you may confidently submit any documentation in support of your insurable claim. Before undertaking medically-necessary surgery, I would strongly recommend that internal and external preoperative nasal images be submitted, along with a pre-determination of your coverage, to your insurer for the proposed procedure. Preoperative or postoperative denials of coverage, without both written and preoperative image documentation, for later review or appeal, are very difficult to overcome. Appeals for coverage of claims are first made, with the assistance of your surgeon, to the third-party insurer medical review process. If you believe your claim is being repetitively denied, without merit on the part of your insurer, a final investigation and appeal for third-party coverage of your claim may be conducted by either your state's insurance commission or state medical licensing agency.

My own cosmetic surgeon would not do both at the same time because he said it would border on insurance fraud. So I got my septum fixed and said heck with the nose-job.