How to Get Insurance to Pay for Rhinoplasty Nosejob!

Well... at least part of the cost. I learned of this from a patient who came to see me in order to obtain an "independent ENT evaluation" regarding her deviated septum.

In essence, in order for insurance to pay part of the cost of one's rhinoplasty, a few things need to happen.

Step 1:
See a plastic surgeon who will perform your nosejob rhinoplasty. If the plastic surgeon notes a deviated septum or if you also have a significant nasal obstruction, see an ENT. If the plastic surgeon is also ENT board-certified, you still need to see a DIFFERENT ENT in order to obtain an "independent evaluation."

Step 2:
See the ENT who will hopefully agree that there is a significant deviated septum contributing to one's nasal obstruction. Septoplasty IS an insurance covered procedure in order to address the medical condition of nasal obstruction. In the medical note, I've typically phrased the report as follows:

"The patient does have a significant deviated septum to the right (or left as the case may be) resulting in nasal obstruction. In order to correct this problem, it is recommended that the patient undergo a septoplasty procedure. However, given that the patient is to undergo a rhinoplasty by a plastic surgeon and instead of putting the patient under anesthesia twice, it is reasonable to have the septoplasty performed at the same time."

Please understand that if you do not have a significant deviated septum, that is exactly what will be reported!

Step 3:
Give the plastic surgeon the ENT report. Here, a little effort will be needed on both the patient and plastic surgeon's part. More than likely, insurance will deny payment for the surgery. As such, the plastic surgeon will need to write a letter of medical necessity including supporting documentation from the independent ENT evaluation. The insurance may still refuse payment and that's when the plastic surgeon may need to perform a peer-to-peer review.

Generally speaking, the insurance in the end may cover some of the anesthesia and rarely the septoplasty component of the rhinoplasty. As such, a few thousand dollars may at least be saved.

Hope this information helps!

What To Do With a Broken Nose?

The only reason to see a physician immediately after an injury to the nose is to assess whether a septal hematoma has formed. The septum is a wall that divides the right nasal cavity from the left. If a hematoma has developed (which is VERY rare), it needs to be drained in an approach similar to doing a deviated septum repair.

Regarding the "broken" nose itself...

I personally think getting an X-ray to look for an isolated broken nose is a waste of time and money. Perhaps the ONLY time I would think about getting it is for legal reasons (the victim plans to sue the assailant if applicable).

However, my standard spiel is one only does something about a nasal fracture (surgically) if there is a problem with

1) Function (ie, can't breath through the nose due to fracture and not because of mucosal swelling)

OR

2) Form (cosmetically unacceptable to the patient once soft tissue swelling goes down all the way)

Otherwise, you do nothing... even if it is clearly broken on X-ray (if one was obtained). If the answer is affirmative to the one or both of the above, than you fix it. Therefore, why bother with the X-ray if it doesn't change management?

In any case, the best thing to do if there is a concern for a broken nose is to ice it like crazy (20 min on, 20 min off in cycles throughout the day while awake), keep the head elevated (even when sleeping), and take motrin for any pain/discomfort.

These measures minimize and resolve any swelling as quickly as possible.

Make an appointment with a plastic surgeon or ENT within 3-5 days.

If there is concern for other facial fractures beyond a broken nose, go to the ER and make sure they get a CT of the maxillofacial (no contrast).

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For the athlete with a broken nose who wants to keep active, recommend getting a nose guard like this: