Can I use "deviated septum" as excuse for rhinoplasty to get insurance coverage?

Repairing a deviated septum does NOT change the appearance of your nose. It is a completely different procedure from a "nose job".

I had a deviated septum repaired last September. They go in through your nostril and remove bone from your septum to reshape. The septum is the bone that divides the two chambers of your nose. So you can not see if from the outside.

The Dr does a Cat Scan to see the bone structure. So, yes, its very easy to prove if you have a deviated septum or not.

The dr will not take photos of your nose. There is no reason to. Your nose looks the same with a deviated septum as it does with out. You can't tell from looking at a person's face if they have one or not.

I was born with a deviated septum. Ever since I was a kid, dr's would look in my nose at visits and tell me I had a deviated septum. It was that obvious. It was very easy to see on the Cat Scan. My dr even joked about it being a no brainer.

Also - since a deviated septum is not a cosmetic procedure, it is not repaired by a plastic surgeon. It's done by an ENT (Ear, Nose, Throat dr).

I had a deviated septum that restricted air by about 70% in one side of my nose. Repairing it was deemed a medical necessity and my health insurance paid for it. I have had great results with it -- so if you actually have a deviated septum, I do encourage you to see about getting it fixed. However, it will NOT alter the appearance of your nose.

If you want to do a cosmetic proceedure, you may want to see if your dr takes care credit. This is like a credit card that pays for medical proceedures. Many health care provides and vetrenarians take it. www.carecredit.com or you can see if your surgeons office will finance it for you.

Had I not had insurance, the total cost for the repair of my deviated septum would have been about 16,000.

'Deviated septum' alone is not a valid reason for a septoplasty to be covered by health insurance. The deviated septum would have to be obstructing your breathing in some way.

In addition, a septoplasty involves reshaping the cartilage within the nose that divides the nose down the middle. This only makes a very subtle difference to the outer appearance, so it is a functional, not a cosmetic, procedure. The procedure you appear to be looking for is a rhinoplasty, which involves resculpting the actual bony structure of the nose as well as the alar cartilages at the side of the nose. A deviated septum, however, is not an indicationfor rhinoplasty.

In summary, a cosmetic rhinoplasty will give you want you want, but cannot be justified on the basis of a deviated septum. A septoplasty, which can be justified by a deviated septum that occludes the airway, will not give you the result you are looking for and will simply be an uncomfortable procedure with no benefit....

Good luck

Deviated Septum Pictures

Deviated Septum Surgery Pictures

Hi there,

By your question I'm assuming that you're interested in purchasing insurance for the purpose of obtaining the rhinoplasty, is that correct?

While I'm not a plastic surgeon, I have extensive experience in the health insurance field, and from that experience I can tell you the following:

1) If you're applying for coverage and have a condition (such as a deviated septum) that may need to be resolved with surgery in the future, you will want to include that in your application and that may preclude you from obtaining coverage.

2) If you have coverage and you're looking to get the surgery paid for by the insurance company, some companies require additional medical back up in order to show proof of medical necessity before covering surgeries of this type. Meaning, they want to make sure it's not a cosemetic surgery attempting to get covered under health insurance.

The payment for the surgery will depend on if the services become authorized and that will depend on the medical records your surgeon provides to the insurance company.

Good luck!

Kathy K

www.premiumwatchdog.com

You can only use "deviated septum" if you actually have a "deviated septum." It would be unethical and unprofessional for a doctor to lie and say that you have a DS when you actually don't. Doctors get audited from time to time and if your MRI Scans don't prove that, they can get into a lot of trouble. There is no reason for them to "vouch" for a stranger like you and risk getting their license revoked.

I also want to mention that MSDA's first sentence is wrong. Your nose would certainly look different if doctors correct a deviated septum. If you have a deviated septum, your nose is most likely crooked. When the deviated septum is straightened, you better believe you will notice the different. But that is NOT a rhinoplasty. It is a septoplasty.

Some patients, like me for instance, are eligible to get a septorhinoplasty AND for it to be covered by insurance, like Kaiser. However, your nose needs to be pretty much destroyed with a lot more than simply a deviated septum. Trauma and nature have messed up my nose. I have a deviated septum, weak nose cartilage that may collapse my nose at some point, bridge of nose too narrow, turbinates issues. All those problems lead me to suffer from breathing issues, headaches, apnea, smelling phantom odors, etc.

I spoke to my doctor at Kaiser yesterday and he advises me that my nose will definitely change. For the better, but it will change. My nose, believe it or not, is small and cute. The extent of the damage is only see via MRI Scan. So I am a little scared. He said that petite noses may look cute, but they are not functional. I will have to build up stength and call to schedule my surgery soon.

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RE:

Can I use "deviated septum" as excuse for rhinoplasty to get insurance coverage?

My insurance company does cover deviated septums. However, the reason I want coverage is for cosmetic reasons.

The insurance company does not have to know this and essentially cannot prove this...

Is it possible the surgeon will see the procedure as a deviated septum? And would he vouch for...

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No. Rhinoplasty is a cosmetic procedure and most plans do not pay for cosmetic surgery. However, many plastic surgeons have payment plans available. A deviated septum is Not repaired using rhinoplasty. They do a septoplasty to repair a deviated septum. They go through your nostril for it. Repair of a deviated septum does not change the appearance of your nose. (had deviated septum repaired a few years ago)

I am not a plastic surgeon, but I do work for a health insurance company. Most insurance will cover that type of procedure if it is medically necessary and appropriate. In order for it to be covered, it is highly likely, that your plastic surgeon will have to send medical records, including pictures to your health insurance companies medical review area. They will need to send documentation of what medical issues it is causing, and possibly supply photographs. If a physician were to send this to your insurance company when you really do not medically need the procedure that would be considered insurance fraud, plus the medical provider would be in breach of contract (if they are participating) with your insurance company. So, if you do not really have a deviated septum, then you should be very careful if you try to get it approved by insurance, insurance fraud can have big fines and jail time (for you and any doctor that tries to vouch for you if you do not have the medical condition). Plus you just posted this on the Internet, proving you knowingly committed the fraudulent act.

It would be difficult for you to achieve what you're asking. (Not to mention fraudulent.)

You'd have to get a prior authorization from the insurance company, including sending your past medical records. The records would need to show documentation of non-surgical efforts to deal with the issues caused by your "deviated septum." Most insurers will also require photographs of your nose from multiple angles.

Its not just a matter of getting a plastic surgeon to say "hey, this is not cosmetic." You'll need extensive documentation to back it up.

(And as a side note...its people like you who make it more difficult for patients who have legitimate issues with deviated septums to get approval for surgery to fix the problem. The insurers have to carefully scrutinize every request for prior approval to make sure it isn't a scam for cosmetic surgery.)