Rhinoplasty (nose job or nose surgery) is considered to be a cosmetic procedure. However, patients often want their rhinoplasty to be covered by insurance. While this is not common, it may be covered by insurance if the deformity of the nose is causing breathing problems.
Only your surgeon is eligible to state the reasons why you are having rhinoplasty surgery. Those procedures which are not considered as a necessity by your insurance company will not be covered.
If your physician feels that rhinoplasty procedure is necessary to improve your health or life quality, he/she can file the required forms for the insurance company to allow the surgery.
Rhinoplasty is considered medically necessary only in the following limited circumstances:
- When it is being done to correct an external deformity of the nose in case the patients are born with cleft lip and palate and other craniofacial birth defects.
- When it is being done to correct chronic breathing problems as a result of middle vault collapse due to an accident, tumor, or a birth defect. The following clinical criteria all need to be met:
• The nasal deformity must be able to be seen in photos.
• There must be an average 50 % or greater obstruction of nostrils documented by endoscopy, CT scan or other appropriate imaging modality.
• The breathing problem cannot be caused by an internal problem of a deviated septum or enlarged turbinate bones.
In short, only external nasal deformities that are caused by a cleft/craniofacial birth defect or middle vault collapse will qualify. Both must be well evidenced in photos which are a required part of the predetermination process.
Tags: nose job, nose surjery, Rhinoplasty