How to get septoplasty covered by insurance?

Tips for getting insurance to cover your septoplasty?

Insurance companies are infamous for not covering medical expenses that have anything to do with cosmetic surgery. They take this step because of their policy that prioritizes health over appearance. But is it the same case for septoplasty concerning the nose area? Does insurance cover it? If not, how to get septoplasty covered by insurance? 

How to get septoplasty covered by insurance?

The answer to this question is tricky, as insurance policies from different companies vary all the time. Essentially, your insurance company should and most likely will cover septoplasty if it has an important goal. However, if your deviated septum is causing frequent infections and air blockage, surgery will be considered medically necessary and surely be covered by insurance. But if it’s for cosmetic or reconstruction purposes, the insurance company will not abide by your request, and you will have to pay for it from your pocket.

How do you qualify for septoplasty?

As mentioned above, insurance companies only cover septoplasty when deemed a medical necessity. Here are the criteria required for a septoplasty to be covered by health insurance companies:

S. NoConditionDoes Insurance Cover It?
1.Nasal septum trauma resulted in a functional deformity not present prior to the injury.Yes
2.A crooked septum produces chronic nasal obstruction and results in significant medical disabilities like purulent sinusitis.Yes
3.Performed as a part of a cosmetic or reconstructive procedure.No
4.Unusual face pain that originates from the nasal area and is only relieved by septal anesthesia.Yes
5.The patient is suffering from obstructive sleep apnea.Yes
6.The patient has a nasal spur or septal deformity causing abnormal air flow with frequent nose bleeds.Yes
7.Impending septal perforationYes

Is septoplasty a minor surgery?

Septoplasty is a minor surgical procedure through which you can breathe better if you suffer from breathing issues. While septoplasty is generally deemed a safe and standard surgery, it still requires general anesthesia and is performed in an operating room. Patients are generally discharged the same day and must take some time off to let it heal.

Can septoplasty change nose shape?

During septoplasty, the surgeon may remove or reposition the cartilage and bone in the nasal septum, altering the shape of the nose. This may be a desired outcome for patients who want a makeover and get rid of a crooked nose or a bump on the bridge of the nose. However, septoplasty is not a cosmetic surgery, and any changes in the nose’s appearance are secondary to the primary goal of correcting the fundamental issues caused by the deviated septum.

If you are seeking notable changes to the formation of your nose, consider a separate cosmetic procedure, like rhinoplasty. 

Is septoplasty a permanent fix?

Not really; septoplasty can provide long-lasting relief from symptoms such as nasal obstruction, congestion, and difficulty breathing when performed successfully. But, in a few cases, the septum may shift back into its original position after some time, especially if the patient experiences trauma to the nose that affects the structure of the nasal passages. Some patients may have persistent symptoms after surgery due to allergies, nasal polyps, or structural abnormalities in other nose parts.

Regular follow-up appointments with an ENT specialist can help monitor any changes in the nasal passages and determine if further treatment is necessary. 

Wrapping It Up

If you need septoplasty for severe reasons, your insurance provider should help you, so we urge you to read their policies carefully. If not, consult your doctor and let them provide proof of severity so you can claim your rightful insurance. 

You must also know: How to get insurance for bariatric surgery?

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