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

Question

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 me?

I would like a plastic surgeon to answer. Thanx!

Answer 1

only an unethical Doctor would do that.

Even then the insurance company would want proof .

So you want to steal and cheat the insurance company and you want the Doctor to commit the crime too.

Good luck.  Check you morals at the door.

Answer 2

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Answer 3

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.

Answer 4

'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

Answer 5

this is absolutely... the insurance comapny is offering you coverage for deviated septums but you want it for cosmetic reasons! Wow that's wonderful!!!!!!!

http://www.rghins.com/

Answer 6

If you have trouble breathing and an  increased number of colds and whatnot part of the surgery WILL be covered by insurance.  It also depends on the hospital because the hospitalization costs might be mostly (if not entirely) covered by insurance.  You'll just owe the surgeon for the cosmetic portion.

Same with the anesthesiologist as it may be covered by the insurance entirely or partially.  I had it done and I had him break the nose because I wanted to be able to breath equally out of both sides.  I only owed the doctor for the 'cosmetic' portion but insurance covered everything else.

Answer 7

Nope.  See, for a deviated septum, they scrape out bone on the inside of the nose.  It's not particularly expensive.

A nose job, has more work, more ingredients, and costs a LOT more.

If you want a plastic surgeon to answer, go call one near you.  But realize that you're asking him, "Will you commit insurance fraud for me?"

Answer 8

If you do have a deviated  septum, a rhinoplasty is not a procedure necessary to repair such a situation.  You would need a septoplasty, and that is not a procedure generally performed by a plastic surgeon.

Good try, but this one isn't going to fly.

Answer 9

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

Answer 10

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.

Answer 11

Here's how  it works. The surgeon would have to get pre approval from the ins co and supply them with a diganosis.  

Yes, the ins co does have to know this.  And unless there is a medical necessity for this prodcedure, you're out of luck.

The ins companuies do not  tolerate insurance fraud, and they  will prosecute.

Answer 12

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.)