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-   -   Fine line between functional and cosmetic rhinoplasty (http://www.plasticsurgeryspot.com/nose-surgery-primary-revision-rhinoplasty/2620-fine-line-between-functional-cosmetic-rhinoplasty.html)

John 05-06-2011 11:40 AM

Fine line between functional and cosmetic rhinoplasty
 
How can I get insurance to help me pay for rhinoplasty?

Within last couple years, the alar cartilage on the left side of my nose (near the tip) has collapsed. It's getting more pronounced as time goes on.

Went to plastic surgeon for consultation. Said for insurance to cover it, collapse would have to affect my breathing. And it does somewhat, though most of the bother comes from it feeling uncomfortable (weird), and yes, I hate the look of it. I want my old nose back. Air can still get through my left nostril, but wheezes its way through.

$3 thousand and some dollars was quoted for the surgery, which is a lot for me. Is there a way to go about getting a successful pre-determination for a functional rhinoplasty covered by my medical/hospital insurance?

Any advice would be great!

TRC 05-06-2011 06:02 PM

I think that if you talk with your surgeon, explain your budget scenario, and tell him how it is a fact that fixing this issue cosmetically would also fix the problem internally (popping the cartilage outward/supporting it with grafts would both give a functional and cosmetic positive), then he may say that it is worth submitting it to insurence and even back you up.

You could even tell him/tell your insurence you bumped your nose some months out of the last surgery - since fractured cartilages are a internal problem that insurence should be more willing to cover, then you probably could even center this repair around an "accident" that happened (and that "accident" could be something as small as anything - even bumping the nose on a table or such.) I'm not saying you were involved in an accident, I'm just saying you could stretch the truth. Fractured cartilages are repaired the same way no matter if it was an injury or previous doctor that caused it, and once your new surgeon's inside your nose, he's should do what's truly needed no matter what was said in consult or what diagnosis was submitted to insurence. Of coarse, NEVER lie about having previous surgery, always be honest about what a previous surgeon caused or did, but external/internal problems could *cough cough* have only appeared after an "accident" *wink wink* during the healing time. You don't exactly have to blame it on your past surgeon word for word, though never leave out the facts of what he did.

The insurence company may require any medical records from any "accidents" though, so I'm not sure, they may not have any sympathy for the a "I fractured my nose bumping a door and I never went to get it checked out." excuse, if you opt to bend the truth.

And basically, yeah, I am saying stretch the truth/talk your surgeon into stretching the truth because for years, I have been on a rampage and gathering studies that show cosmetic deformities that cause noticeable appearance and even slight functional problems affect patients to the point they loose jobs, loose sleep, get sick, get depressed, and even commit suicide over the issues. Our government and most insurence policies don't even pay for therapy for dealing with defects, much less pay for the defects themselves, but I'm hoping to change all that as I am building a name for myself in many respected fields - but this type of change won't happen for at least another 20 years, so in the meantime, get what you deserve out of your insurence company!

But $3,000 out of pocket (without insurence) seems incredibly low for a revision rhinoplasty - most revision rhinoplasties that involve cartilage repair are at least $9,000 (though your surgeon may be knocking down the price if it's a small area.) Just make sure you're not going to a behind the junkyard plastic surgeron, and make sure he's qualified to do revisions and belongs to the ABPS. $3,000 is just the cheapest rhinoplasty I've ever heard of in my life.

Rskull 05-08-2011 05:31 PM

If it is for functional purposes you can have money but for cosmetic reasons no. Ask and negotiate with your surgeon to give you a sort of price for functional reasons and you pay something more from your pockets for the cosmetic part. However, in the US insurance againcies are quite cautious and sceptic in this since some surgeons were abusing it.

KristenMarie 05-13-2011 11:47 AM

Quote:

Originally Posted by John (Post 10730)
How can I get insurance to help me pay for rhinoplasty?

Within last couple years, the alar cartilage on the left side of my nose (near the tip) has collapsed. It's getting more pronounced as time goes on.

Went to plastic surgeon for consultation. Said for insurance to cover it, collapse would have to affect my breathing. And it does somewhat, though most of the bother comes from it feeling uncomfortable (weird), and yes, I hate the look of it. I want my old nose back. Air can still get through my left nostril, but wheezes its way through.

$3 thousand and some dollars was quoted for the surgery, which is a lot for me. Is there a way to go about getting a successful pre-determination for a functional rhinoplasty covered by my medical/hospital insurance?

Any advice would be great!

I'd say no. I have broken my nose 3 times and had a septal spur which required septoplasty. I also had a hump from the break and it was painful every time it was bumped. CT scans showed roughly 85%-90% of breathing was blocked because of the spur on one side of my nose. Insurance even tried to challenge the septoplasty, but eventually paid - but definitely didn't even consider paying for the rhinoplasty portion of the surgery. You may find some doctors who can "con" the insurance, but usually a reputable doctor wouldn't even attempt it. I had mine done by an ENT and the cost was $3000 for the rhino and then the septo was covered 85% by insurance. For the rhino, the doctor gave me a interest-free payment plan so long as I paid $1000 up front.


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