Many patients interested in rhinoplasty wonder if their insurance plans will cover the cost of the procedure. In fact, “Will insurance pay for a rhinoplasty?” is one of the most common questions asked at The Ear, Nose, Throat and Plastic Surgery Associates during a patient’s initial consultation.
The answer? Well, it depends on the type of rhinoplasty.
When the primary purpose of the rhinoplasty is to shape the exterior of the nose it is often referred to as a cosmetic rhinoplasty, whereas a functional rhinoplasty is typically focused on shaping the interior passageways of the nose, usually to help improve breathing.
Jeffrey J. Lehman, M.D., F.A.C.S., a board-certified otolaryngologist with training in facial plastic surgery, says many patients not only come to his practice to address difficulties with breathing, but also cosmetic issues they’d like to fix at the same time.
“It’s certainly possible to address both issues at the same time. The question normally becomes ‘Is this something that my insurance is going to cover?’ and that’s always a matter of degree and it always a determination that is accomplished by back and forth with the insurance plans and sometimes appeals,” he explains.
In many cases, if the deviation or deformity of the nasal framework is significant, and contributes to airflow obstruction, the insurance company will cover the rhinoplasty as a functional procedure under the patient’s plan.
“In other instances, the insurance companies will say no, this is simply not a covered procedure or they’ll say the case is not sufficient in degree to be labeled as functional,” Dr. Lehman says.
Patients can still have the procedure done if their insurance won’t cover it, but the rhinoplasty would be classified as cosmetic.
“In these circumstances, we bill the functional portion of the rhinoplasty under insurance, and then we bill the external work separately as a cosmetic procedure to be paid out of pocket,” Dr. Lehman explains.