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Is rhinoplasty covered by my health insurance?

Keep in mind...
  • Rhinoplasties are sometimes covered
  • Medically necessary rhinoplasties for breathing difficulties or facial reconstruction reasons are usually covered
  • Rhinoplasties for cosmetic reasons are not

Unfortunately, there is no easy answer to the question of whether or not your rhinoplasty would be covered by your health insurance. The best way for you to find out is to contact the customer service representatives from your health insurance company and ask them. However, they might not be able to give you a definite answer. Rhinoplasties are generally either covered or not covered on a case-by-case basis for most insurance policies.

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There are some general rules of thumb, which will be discussed in this article for the coverage of rhinoplasties. Each insurer is different. As a general rule, a rhinoplasty that is done to help a patient breathe better or to reconstruct a damaged nose is covered under most health insurance plans.

Another general rule is that rhinoplasties done for cosmetic reasons are almost never covered under health insurance plans. However, they may are there may be a few exceptions to this rule. To learn more about whether your rhinoplasty would be covered or not, read on.

Why Some Rhinoplasties are Covered

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As with other procedures, insurers generally decide whether or not to cover rhinoplasties based on the principle of medical necessity. This means that if you have a medical need for treatment, as determined by a licensed doctor, then the insurer will likely cover the treatment. The most common types of rhinoplasties that are covered by medical insurance are done so that the patient can breathe better or to repair damage to the nose.

Only a doctor can determine if a patient needs a rhinoplasty in order to breathe better.

Generally, a doctor will only prescribe a rhinoplasty if the patient has significant breathing difficulties and can see considerable benefits from getting a rhinoplasty. This is be

cause surgery, especially on such a delicate part of the face, is generally seen as the last option. Speak to your doctor to see if this is right for you.

If you have suffered severe damage to her nose, you may be able to get your insurer to cover a reconstructive rhinoplasty. Again, you must speak to your doctor, probably a plastic surgeon, to determine if surgery is necessary. Reconstructive rhinoplasties are usually covered as long as they are deemed necessary by a licensed doctor. However, patients sometimes have a harder time getting their insurer to cover reconstructive rhinoplasties as opposed to rhinoplasties that would allow a patient to breathe better.

Why Some Rhinoplasties Aren’t Covered

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As previously mentioned, the general rule of thumb is that rhinoplasties done for cosmetic reasons are not covered by medical insurance. As with everything, the coverage differs from insurer to insurer and you should contact your insurer to make sure that you are up-to-date on their procedures. If you do decide you want to get a rhinoplasty for cosmetic reasons, there is still a small chance that you can get your insurer to cover it.

If you can prove that you have a mental condition that will be alleviated by getting a rhinoplasty, such as a body image disorder, you may be able to get your insurer to pay to cover the procedure. However, this is rare. You would generally need to get authorization from your psychiatrist and your plastic surgeon before you and going to your health insurance company.

Comparing Insurance Plans

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If you are thinking about getting a rhinoplasty, make sure to research the different policies available to you when you’re comparing quotes online. Look at the fine print and see what the insurer does and doesn’t cover. Also, do as much research on the insurer as possible to see if they generally cover plastic surgery procedures. It is a good idea to read reviews from other patients of every insurer.

Health insurance can be a complex issue, so always try to be as informed as possible. It may even be a good idea to get the insurer’s contact information when you are comparing quotes and call them up and ask them directly. You may have trouble getting through to a customer service representative if you are not a policyholder, but you can probably manage it if you try hard enough.

Appealing Insurance Company’s Decision

If your insurer initially denies your claim, you can most likely appeal it. All of the major insurers have a denial appeal process. For the best chances of getting the insurance reverse their decision, speak to your doctor and have them help you with the process. They have likely helped other patients through the process before, and perhaps even have professionals working for their office that specialize in dealing with insurers.

Keep in mind that the doctor wants to make sure they get paid as quickly as possible, and the best way for this to happen is usually through an insurer. Yes, they do have a vested interest in helping you out.

Options Besides Insurance

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If you’ve tried everything and you cannot get your insurer to cover your rhinoplasty, you still may have options. Many plastic surgeons these days offer installment plans and financing. With an installment plan, you would pay for your surgery in installments before the procedure actually takes place.

The plastic surgeon would schedule it and hold a place open for you on their often busy itinerary until you finish your payments. If you would prefer to have a procedure done now rather than later, you may be able to get financing.

Of course, this depends on your income and credit. If you have a good income and credit you can probably get a loan for your rhinoplasty. Speak to your plastic surgeon about this option. They may be able to help you get financing with very low interest rates.

Your Next Steps

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Your first course of action is to research different insurance plans when comparing quotes online. This will give you a good idea about whether or not the insurer usually approves this sort of procedure. After buying a plan, call the insurer and ask them. Also, remember to speak to your plastic surgeon and be honest with them regarding the situation.

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