Deviated Septum Insurance: What are Your Chances for Coverage?

One of the first concerns anyone going in for any kind of surgery in the U.S. has is whether the surgery is covered by a private health insurance company.

If you have decided to opt for surgery to correct your deviated septum, the question of deviated septum insurance could be on top of your mind. Before we get our doubts in this area clarified, it might be a good idea to know a bit more about the policies of health insurance companies in this country.

Deviated Septum Insurance: Some Basic Facts

Here are some broad points which can give you a fair idea about your prospects with deviated septum insurance:

• “Predetermination” by health insurance companies is necessary for selected inpatient and outpatient medical services including surgeries, diagnostic procedures, etc. This is necessary to determine whether the planned procedure is a ‘medical necessity’ or merely a ‘cosmetic’ procedure.

• The surgeon has to notify the insurance company, giving every detail about the diagnosis of your condition, including medical symptoms and the necessity of the surgery. The important factor here is there ought to be some medical symptoms existing like breathing difficulty etc.

• Simply because your nose appears ugly or a birth defect has to be corrected is not deemed ‘necessary’ by many insurance companies.

• The process is not quick – you may have to wait for about a month to get a response from the insurance provider to the letter written by your surgeon.

As you can see, the subject of deviated septum insurance is not as simple as a walk in the park – and there are several ‘ifs’ and ‘buts’ which you need to keep in mind. In short, for you to receive insurance benefits for a plastic surgery procedure (rhinoplasty is mostly considered this) it has to be authorized or ‘pre-certified’ before the surgery is done.

Pre-determination and pre-certification are two parts of the same procedure but pre-certification can be done over phone or fax between your surgeon and the insurance provider.

What You Need to Know About Deviated Septum Insurance

Let us now summarize some of the most important facts regarding deviated septum insurance coverage in the U.S. and your future prospects on claims:

• The insurance contract is between you and the insurance company and not between the surgeon and the provider. Therefore, if you want deviated septum insurance, you may have to pay the surgeon first and then claim the amount from insurance later, or, spend an enormous amount of time trying to convince the insurance company, with very little chance of success.

• Septoplasty may be covered, provided you meet a list of requirements – but a nose job or any type of cosmetic procedure may not be.

• You are likely to get deviated septum insurance coverage if the surgery is performed because of medical necessity. The medical necessity in this case is because of acute breathing difficulty.

• Some of the diagnostic reports that the deviated septum insurance may require include report of imaging study like a CT scan.

• To understand the deviated septum insurance coverage better you need remember that the ‘reconstructive’ portion of the surgery (i.e. septoplasty) done to improve your breathing is usually covered while the ‘cosmetic’ portion of the procedure which may include straightening a crooked nose may not be.

• Deviated septum insurance coverage may vary greatly according to the specifics of the health care plan that you are under. Therefore, to know your best options, it might be a good idea to discus the matter with your surgeon and the insurance company to get the ‘pre-authorization’ prior to the surgery.

Though the insurance provider may not pay for the cosmetic portion of the surgery, they are likely to pay a substantial amount involved in the surgical center fees and the cost of anesthesiologist. This can help in bringing down the overall cost of the surgery.