Insurance Might Cover Your Rhinoplasty (Here's How)

Dr. DeBusk (00:11):
Welcome back to Behind the Double Doors. I'm Dr. Taylor DeBusk, and today we're going to talk about rhinoplasty and whether insurance can or cannot cover your procedure. So oftentimes patients ask about insurance coverage for rhinoplasty. And the short answer is yes, insurance can cover a portion of the procedure. A lot of times with rhinoplasty, patients have functional issues or functional concerns. Can't really breathe out of the nose whether they were born with a deviated septum, they've sustained nasal trauma that results in inability to breathe well through the nose, or some people snore significantly as a result of some sort of structural issue in the nose. In those cases, if patients qualify, insurance will cover the functional portion of the rhinoplasty. In several instances, patients do want to make cosmetic changes to the nose at the same time. Typically, it's whether they have a little hump on the bridge or if they want to kind of narrow or refine the tip.

(01:11):
And that can be done at the same time as the functional rhinoplasty. Now insurance doesn't cover those smaller cosmetic portions, but the reality is those cosmetic portions are just a small fraction of the procedure. The vast majority of it is the functional component, which is typically covered by your insurance provider. The most common reasons rhinoplasty or septoplasty would be covered by your insurance is one of the most obvious if you have an obviously deviated septum. So that's something that we can tell not typically externally, but when we look in the nose. So the septum is a piece of cartilage and bone that divides the whole nose into a right and to a left. And if that septum is crooked, protrudes on one side or the other, that can narrow the airway, that's something that we can see. And usually insurance will cover that. Another thing that you typically will see from a functional standpoint in the consultation is whenever you take a breath in.

(02:07):
Oftentimes we can see what's called nasal valve collapse. There's two valves, the internal and external. Whether you have collapse of either one of those with normal inspiration, we document that an insurance usually provides coverage for the surgical repair. Anytime I do rhinoplasty, all those things are addressed anyway. But if you have an obvious deficit, obvious issue that we can document, then insurance usually has no issues providing coverage. Or if you have a history of nasal trauma that's resulted in a deviated septum, broken nasal bones that also create those sorts of nasal airway narrowing that cause you to have a deficit, then yes, that also is an indication. Now, sleep apnea is a big one that a lot of people struggle with and more and more people are aware of it and more and more people are getting treated younger. Looking at the data, specifically with rhinoplasty and sleep apnea, we can't say fixing your nose will cure your sleep apnea.

(03:11):
What the data shows is people with sleep apnea that wear the masks, specifically the ones around the nose. If they're not really compliant with it, you don't feel like it's working and you just stop using it. A lot of times that's because you do have a deviated septum or you have issues with the nasal passages. So rhinoplasty or just a septoplasty by straightening out the nose dramatically improves or increases the compliance with that mask. So it will help with the management of your sleep apnea. Now anecdotally, in my experience, have had a lot of patients where I did a functional rhinoplasty who had sleep apnea and they actually just stopped using their CPAP machine completely and they were getting great sleep, felt well rested and had no signs or symptoms of sleep apnea afterwards. Now that's my experience. I don't have any data. I can't say that if you have sleep apnea and you get a rhinoplasty, it'll be cured.

(04:07):
But I think if you have sleep apnea with obvious nasal issues, deviated septum, valve collapse or any of those things, you can get a dramatic improvement in your ability to sleep by having those things managed. I think one thing people complain about or discuss a lot is that they get congestion on one side of the nose, at some point in the day, and then all of a sudden it's on the other side. So we have these turbinates on the inside of the nose, kind of like a radiator. There are these finger-like projections that help to purify, humidify air when it goes from the nose to the lungs. Now they have something called a nasal cycle. Well, one will swell, the other will contract, and it will kind of oscillate back and forth. And that's why we get these intermittent congestions on one side or the nose or the other.

(04:56):
That doesn't mean you have a deviated septum, but if you always have issues breathing out of one nostril, just one side, even if you take decongestants and you still have, even though it may improve your ability to breathe, you still have more resistance on one side of the nose versus the other. That is usually an indication that you likely have a deviated septum or a valve collapse on that side. It has to always be one side, but there are also severely deviated septums that can curve into one way and it curve into the other and you get obstruction of both nasal passages. So it's not a surefire thing that if you always have issues on one side or you don't, that you do or don't have a deviated septum. It's one of those things that you have to really come to the office, we take a look on the inside of the nose and can really evaluate.

(05:44):
But one thing that we see a lot is, so when we look at the septum, it's kind of L-shaped. So there's what we call the dorsal septum along the bridge, the caudal septum below the tip. Now, if you look up and you look at the midline portion of the nose called the columella, if that thing is way off to one side or the other, then that's called a severe caudal septal deviation. And that's something that you can see without looking in the nose and you know that that can only be managed surgically. It can be caused by injury or you can be born with it. And I've had a lot of patients who think they broke their nose, not sure, or some people that know they have it and they still have a severely deviated septum. It really just depends on how that septum grows.

(06:31):
And no septum is perfectly straight. There's always subtle deviations. It's just, is that deviation big enough to cause airway obstruction? When we evaluate the septum in the office, we look at how deviated it is and you can give it a number, say 50% obstruction, 70% obstruction based off the deviation. And another test we do is called a modified caudal. Basically what we do is we get you to breathe normally. Then we take a Q-tip in the nose at the most narrow part, that internal valve we were talking about, and subtly move it out a millimeter or two, and then you breathe in again. And if you get significant improvement, and we always try to gauge it, say 25, 50, 30, or 0% improvement, based off that number, it'll tell us whether you're a good surgical candidate or not. And these are the numbers, these are the things along with our physical examination that we submit to insurance.

(07:28):
And usually if you hit a higher number, middle to high number, typically there's no issues with insurance coverage. Granted, it very much depends on who your insurance provider is. Obviously, there's no guarantees that before we see you, whether it will or will not be covered by insurance. I think if you have had longstanding issues with breathing through your nose, specifically when you exercise, if you breathe your mouth breathe or at night, you only breathe through your mouth. Those are kind of very consistent findings that you see in patients that translate to severe enough deviation that will be covered by insurance. Again, just because you have allergies and just because you have fluctuating congestion, fluctuating nasal obstruction, sometimes it's worse in specific time of the year, or it's worse on one side at one point, on the other at the other. That doesn't necessarily mean that you have a deviation.

(08:25):
I mean, it's still worth coming and getting checked out to see whether or not it will be covered by insurance. But a lot of times, we see patients that their primary goal initially is to make some cosmetic changes, and they also have breathing issues. So that's what we typically see. But that being said, if you do have issues breathing through your nose, or if you've even been diagnosed with a deviated septum in the past, then it's a very high likelihood that these will be covered. Some of the things that we ask when we're evaluating the nose is, "What have you done? Have you used topical steroids, nasal sprays, fluticasone is the most common?" Do you do the irrigations? Do you do this nasal strip? Do you get improvement? These types of things are good for us to know. And then obviously the more you do, the more documentation we have that you failed conservative treatments increases the likelihood that insurance will cover the functional portion of the procedure.

(09:22):
Usually when I see patients, especially in South Texas, everybody's got allergies to some degree. So they've been on antihistamines oral, topical steroids, topical antihistamines for years with minimal improvement. So usually when I see patients, they've already been through the gamut of over the counter medical management, but these things are great to document and all they do is help the likelihood that your procedure will be covered by insurance. So when you come in for consultation, specifically for rhinoplasty, regardless if you want any cosmetic changes or not, I'll go over the nose in its entirety, the anatomy, kind of the ideal shapes of different parts of the nose, then we'll look on the inside. And before we do that, we get a full history, see what you've done to manage your symptoms and what are your symptoms at baseline? And these things kind of lay the foundation.

(10:21):
Then we look on the inside of the nose and we see the septum, we see if there's any sort of deviation, any sort of inflammation, allergic swelling, those types of things. And then we do the functional tests. So that's where we use the Q-tip. We get you to breathe, use the Q-tip, see if you have improvement. The vast majority of people that I see, because they have nasal issues, have dramatic improvements with those maneuvers, and it's a good marker specifically for me that you are a good candidate and that you would improve with a septoplasty or a functional rhinoplasty. Then after that, after we get all of our documentation, photographs, all those things, we submit them to your insurance provider, and then the rest is in kind of the insurance provider's hands, whether they're going to accept it, whether they need more information, whether they need to have a direct conversation with me about the patient's anatomy, the situation.

(11:16):
And then once they approve it, then we schedule the surgery depending on the patient's schedule. Sometimes it can take a couple weeks before they'll give the approval, and then as soon as we get the approval, then we set up with one of our outpatient surgery centers or the hospital depending on the patient's medical history and schedule the procedure and then move forward. When patients come in and their primary objective is just to breathe better, there are obvious improvements of the overall contour of the nose that could be made, but the patient doesn't bring it up. It's not something that I necessarily say, "Hey, we should fix this, this, or that. " Because everybody's nose, a lot of people, the shape of their nose goes hand in hand with their identity because it is their nose, their face. So that's why every time I look at a nose, whether it's functional, cosmetic combination, I always talk about the entire nose, the anatomy, the bones, the septum, the cartilage, the ideal shapes, the typical shapes, because not everybody wants to have a rhinoplasty nose or not everybody wants to address the hump.

(12:18):
And I've had a lot of patients that have humps and they don't want to bring it all the way down. They just want to make it a little bit less because they still want it to look like their mom or their dad. Again, because a nose is a big part of a lot of people's identity. That being said, some people are maybe a little apprehensive to talk about making changes to the shape of the nose. And that's why I try to make people comfortable. I want you to be able to address or bring up any issues or concerns that you have. Whether we surgically manage it or not, that's up to the patient, but I always talk about the shape as well as the function. Now, when we talk about different functional surgeries, there's two with the nose. One is just the septoplasty. So that is where everything's done internally.

(13:03):
There's no incisions that are visible. There's no changes to the shape of the nose. That's where we just go in, make a little incision on the inside, and then remove that deviated septum, and that's it. Easier recovery, and there's no changes to the shape of the nose, much less swelling because we're not doing anything to the soft tissue. Now, a functional rhinoplasty is different. Now, patients that have severe deviations of the septum where we have to address that caudal septum, like we were talking about earlier, or very crooked nose, those noses, we have to do the full functional septoronoplasty. And I know we've talked about in the past, kind of what to expect from a recovery standpoint and swelling and when you're going to see kind of that final shape of the nose. So that's something that I talk about with patients, because if you have a deviation of the back septum, that's easy to fix with just a septoplasty, but then you want to make cosmetic changes to the nose that changes things just from a recovery standpoint.

(14:04):
If you're interested, I mean, the first thing is to give us a call. Our staff here is great about with all the intakes, asking what your issues are, what you've done, if you've had other procedures done for the nose, whether it's surgical, non-surgical. After they do the intake, one of the main things that they ask too is what your insurance provider and your coverage and whether or not you're a candidate or whether or not we accept that insurance before we move forward, because we don't want to waste your time coming in and then in the end, it's not even an option.

Announcer (14:42):
Basu Plastic Surgery and Aesthetics is located in Northwest Houston in the Towne Lake area of Cypress. To learn more about the practice or ask a question, go to besuplasticsurgery.com/podcast. On Instagram, follow Dr. Basu and the team @BasuPlasticSurgery. That's B-A-S-U Plastic Surgery. Behind the Double Doors is a production of The Axis, T-H-E-A-X-I-S.io.