Ask the Doctor: Does insurance pay for nose surgery (rhinoplasty)?

Whether insurance pays for nose surgery (rhinoplasty) depends on the reason for the procedure:

1. Cosmetic Rhinoplasty: If the surgery is purely for cosmetic reasons (to change the nose’s appearance to better suit the patient’s aesthetic desires), insurance typically does not cover the costs. Cosmetic procedures are generally considered elective and not medically necessary.
2. Functional or Reconstructive Rhinoplasty: If the surgery is needed to correct a functional issue or structural problem, insurance might cover some or all of the costs. Examples of functional issues include:
   – Deviated septum, which can cause breathing difficulties.
   – Birth defects.
   – Trauma or injury to the nose.
   – Previous surgeries that resulted in complications or breathing issues.
3. Combination of Cosmetic and Functional: Sometimes, a patient might undergo rhinoplasty for both cosmetic and functional reasons. In such cases, the insurance might cover the functional portion of the surgery, but the patient would be responsible for the cosmetic portion’s costs.

At Richmond ENT we will:

• Quote a fixed price: Cosmetic surgery is not a covered benefit under any medical plan. We will discuss our professional fees in advance and collect payment before surgery. We will provide a time based estimate of surgery center and anesthesia fees and guarantee the total cost of surgery to be within 10% of these estimates.
• Consult with Your Insurance Provider: Before functional or reconstructive nasal surgery, we will speak with your insurance company about what is covered and advise you in writing regarding your estimated out of pocket costs. This can include deductibles, co-pays, or costs above what the insurance agrees to pay.

In summary, while cosmetic rhinoplasty is usually not covered by insurance, functional or reconstructive procedures might be. We will help you check with your insurance provider to understand your coverage and potential out-of-pocket costs.