Rhinoplasty means “nose reshaping”. There are two main reasons people choose to reshape the nose. The first reason is for breathing or “functional” purposes. Sometimes, whether it is due to trauma or how the nose developed from childhood, there are areas of weakness and deviation in the cartilage of the septum and the nasal skeleton which require the nose to be reshaped in order to improve breathing. This is called “functional rhinoplasty” and when the patient meets certain criteria, this surgery can be covered by most major health insurance companies. Importantly, each insurance company may have its own criteria for a patient to be approved for the surgery. It is important to check with your nasal surgery specialist to see if you may qualify. Our office routinely performs a detailed, nasal examination and high resolution photographs of the septum and nasal cartilages which may be contributing to collapse or restriction of the nasal airway. A very detailed exam can help the insurance company recognize that a surgery would be beneficial. Surgery for functional rhinoplasty usually includes septoplasty, repair of the nasal valve (narrowest areas of air entry), repair of any previous nasal fractures and/or treatment of the turbinates – all of which can improve breathing. Nasal breathing is very important to health and repairing nasal breathing can improve athletic performance, blood pressure, and even snoring/sleep apnea. Since the mission of most insurance carriers is to help their members lead healthier lives it makes sense that treatments to improve breathing are routinely covered.
The other reason to perform rhinoplasty or nose job surgery is to reshape the nose for cosmetic purposes. Cosmetic procedures are not covered by standard medical insurance plans. There are numerous studies to show that cosmetic rhinoplasty improves mental health, but cosmetic nasal surgery is not currently covered in the United States. The most common cosmetic requests are straightening the nose, tip reshaping, and removing a hump or making the nose smaller. Many patients who are planning to undergo functional rhinoplasty to improve their breathing, will also desire a cosmetic change at the same time. This is one of the most common situations in our practice. In this case, (assuming the functional criteria are met) the insurance company will pay for the breathing part of the surgery and the patient will pay for the cosmetic portion out of pocket. All surgeries have three fees – surgical fee, operating room fee, and anesthesia fee. Typically, in a case where there is a functional and a cosmetic component, part of these costs will be reimbursed by the insurance company based on how much time is spent on the cosmetic and functional portions of the surgery. Each case is different, so make sure to ask your surgeon if they participate in major insurance plans if you are undergoing a functional rhinoplasty. See our list of in-network participating insurance plans attached here.
Disclaimer: This blog does not constitute medical advice and no doctor-patient relationship is formed by reading it. Prior results do not guarantee a similar outcome. Additional facts or future developments may affect subjects contained within this blog post. Before acting or relying upon any information within this newsletter, seek the advice of a medical doctor.
- Papadopulos NA, Liebmann J, Kloeppel M, Henrich G, Machens HG, Staudenmaier R, Niehaus R. Quality of Life after Rhinoplasty: A Prospective Study. Facial Plast Surg. 2021 Oct;37(5):639-645. doi: 10.1055/s-0041-1725174.
- Saleh AM, Younes A, Friedman O. Cosmetics and function: quality-of-life changes after rhinoplasty surgery. Laryngoscope. 2012 Feb;122(2):254-9.