Insurance specialist
Rhinoplasty, also known as a “nose job,” is a top cosmetic procedure worldwide. More than 350,000 rhinoplasties occurred in the U.S. in 2023. Some want it for looks, while others fix breathing issues or injured noses.
Will insurance pay for rhinoplasty? It’s not always straightforward. We will explore this question in detail.
From a deviated septum to simple reshaping, the difference between medical necessity and a cosmetic request matters for insurance coverage.
Table of Contents
Does insurance cover rhinoplasty?
In some cases, insurance will help with the cost of rhinoplasty if it is necessary.
Rhinoplasty is often thought of as purely cosmetic surgery. However, insurance companies will pay for operations that have a medical need. If the nasal surgery improves function, then the coverage may apply.
Insurance will cover rhinoplasty if your nose causes major problems, such as difficulty breathing or sleeping. You must have proof from a doctor.
Insurance asks doctors to show clear evidence. Doctors show how the problem affects daily life. They may need CT scans or other imaging tests.
If you want surgery only to change your appearance, it is not covered. In that case, you will have to pay for it yourself.
When Insurance Typically Covers Rhinoplasty
There are a number of legitimate medical reasons for having rhinoplasty, and in such situations, the expense may be fully or partly subsidized by health insurance. Here are the most common situations in which this is possible:
1. Correction of Deviated Septum (Septoplasty or Septorhinoplasty)
A deviated septum is a frequent condition where the nasal septum (the partition that separates the nostrils) is deviated from the center, thus one or both of the breathing passages are obstructed. This condition may cause:
- Inability to breathe through the nose.
- Frequent sinus infections.
- Nosebleeds
- Disrupted sleep, such as snoring or sleep apnea.
Operations like septoplasty for the correction of the internal structure, and that have been confirmed with the doctor as significantly impeding breathing, are oftentimes one of the things that insurance covers. Should the surgical intervention also require the outer part of the nose to be shaped for functional reasons (septorhinoplasty), then some varieties of insurance may cover both the inside and outside parts.
Pro tip: It’s critical to always ensure your doctor provides clear evidence demonstrating how the deviation of the septum affects your health.
2. Post-Traumatic Reconstruction (e.g., after a broken nose)
If you have been in an auto crash, got hit playing sports, or fell down causing an injury that changed the form and function of your nose, then the insurance could possibly pay for your reconstructive rhinoplasty.
It involves the correction of:
- Bone injuries in the nasal area.
- Nasal passages twist and fold.
- Irregular breathing
If your surgery is a result of a post-traumatic repair, it means that your surgical intervention is the result of a reconstructive operation rather than a plastic one. Just make sure that you keep the record of the incident (hospital records, ER visits, imaging) and get your surgeon to detail the structural damage and the need for the repair in order to justify it.
3. Congenital defects or breathing difficulties
People with a natural (from birth) deformation of their nose, inside (e.g., deformed nasal valves), or outside (cleft-related or abnormal structure), may qualify for insurance coverage. These conditions often interfere with:
- Proper nasal airflow
- Sleep quality
- Facial symmetry is tied to craniofacial syndromes.
The insurance company will be more prone to allow you coverage if your breathing problems are the result of congenital disorders, provided that the medical necessity is sufficiently documented.
4. Functional Impairments Confirmed by a Specialist
You will always need to have an appointment with the ENT (Ear, Nose, and Throat specialist) or with a certified facial plastic surgeon to make sure your illness is diagnosed properly. These ENT/facial plastic surgeons will in detail:
- Measure airflow in patients (rhinomanometry).
- Request the necessary images (CT scans).
- Write down your complaints (headaches, nasal obstruction, etc.).
These clinical notes will be put into the prior authorization process, which the insurer needs to complete before confirming that the surgery is covered.
To sum up, if there are medical grounds, like in the case of breathing problems or trauma repair, then it is likely to be covered. However, rhinoplasty surgery for the purpose of aesthetics, even though it is what one wants, will most likely not be covered at all.
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4. When is rhinoplasty not covered by insurance?
A lot of people may expect that their insurance company will cover at least part of the cost of their rhinoplasty. However, the fact is that quite often nose jobs are not covered, especially when they are performed purely for aesthetic purposes. Health insurance companies have strict eligibility rules, and they distinguish between what is related to one’s health and what is only aimed at improving the appearance aesthetically. If so, you are likely to be in a position to pay for the procedure yourself.
1. Only purely cosmetic changes.
Even if such a procedure has made a big difference to your image, your self-esteem, and happiness, the fact is that health insurance will not back it if the goal of a procedure is just to enhance appearance. The range of such changes is enumerated below:
- a nasal hump or bump being made slimmer or completely removed
- a nose tip that is made smaller or more refined-looking
- Nostrils are becoming narrower.
- a droopy nose lifted up
- a nose made symmetrical or proportionate to the face
It is of no consequence that you are the one who feels in favor of the changes in breathing ability; unless a healthcare professional can confirm and register the functional aspect, insurance companies will equate the action with an elective procedure and reject the claim.
💡 Tip for readers: Cosmetic rhinoplasty can cost anywhere from $6,000 to $15,000+ depending on the surgeon, location, and complexity. It’s important to budget with that in mind if you are pursuing this route.
2. Procedures Without Documented Breathing Issues or Trauma
Despite a person saying that their nose is out of shape due to trauma or a long-existing breathing problem, rhinoplasty surgery cannot be listed among the insurance-covered surgeries if there are no records on these matters. When a patient doesn’t provide any documentation to back up their claims about the trauma or the breathing issues, then the surgery is automatically classified as non-urgent surgery, and the insurance company will not pay for it.
Here is an instance:
- “I only find it difficult to breathe sometimes.”
- “I tend to snore at night,” or
- “I have always been of the opinion that my nose is ugly.”
…, but doctors have not run any tests to confirm that yet; there is no medical evidence to say so, and the insurer will not believe you.
Another contributing factor is if you have never been diagnosed with a condition (like a broken nose, in this case) or your breathing problems haven’t been reviewed by an otolaryngologist, or you haven’t had a CT scan, then you are probably in for an out-of-pocket charge.
Final Thoughts
Rhinoplasty is considered to be a cosmetic luxury most of the time, but for many people, it actually means breathing easier, sleeping better, and feeling healthy without the problem of any structural disagreement or feeling self-conscious.
It might be seemingly difficult to tell the difference between the two, but when it comes to real symptoms and the right documents, health insurance can come to your aid. The catch is providing enough evidence for medical necessity via proper testing, consultant evaluation, and insurance-conscious language from the doctor.
Before deciding on your treatment or paying for it out of your pocket, it is best to verify with your health insurance provider about the available options. Find out if they cover charges for medically necessary rhinoplasty, pre-authorization procedures, and network specialists.
We’ve gathered the names of the best insurance companies that are mentioned above—just click the links and look for plans, coverage comparisons, or even request pre-qualified appointments. The appropriate coverage can help you avoid incredible bills in the future.
