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Will Health Insurance Cover Rhinoplasty?

by | Dec 21, 2024

Page Tags: 2024 | coverage

Does Health Insurance Pay For a Nose Job?

Nose jobs, officially referred to as rhinoplasty, are among the most common types of plastic surgery. Patients opt for this procedure for a myriad of reasons from improving their face’s symmetry to alleviating breathing troubles. Whether an individual’s health insurance covers the surgery comes down to two factors, including whether it is paid for under their specific health insurance plan and whether the surgery is medically necessary.

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When Does Health Insurance Cover Rhinoplasty?

Health insurance may cover a nose job if the procedure is medically necessary. If the individual does not have full function of their nose due to a deviated septum, a birth deformity, inflammation from chronic allergies, or damage from an accident or injury, the surgery may be considered medically necessary and therefore covered under their health insurance policy. The health insurance company usually requires the individual to undergo nonsurgical treatments for these issues before authorizing payment for the surgery.

ACA-compliant health insurance plans generally cover a large portion of surgical costs for medically necessary rhinoplasty. Each plan is different, however, so before someone schedules their surgery, it is a good idea for them to determine what their cost-sharing responsibility will be.

When Does Health Insurance Not Cover Rhinoplasty?

As is the case with all elective surgeries, rhinoplasty is not covered by health insurance when the procedure is not medically necessary. Cosmetic rhinoplasty changes the overall appearance of the individual’s nose by reshaping it or reducing its size. Commonly, people seek this surgery to create a narrower nose bridge or remove a bump on the bridge, reduce or widen the nostrils, straighten a crooked nose, reshape the tip, or change the angle between the nose and the upper lip.

Cosmetic rhinoplasty can provide a boost to an individual’s confidence and help bring alignment to their facial features. However, while the surgery may correct some psychological problems, it does not address any medical problems. For this reason, patients generally foot the entire bill, which averages $5,483.​

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Partial Coverage for Rhinoplasty

Occasionally, when someone is undergoing rhinoplasty for medical reasons, such as to fix a deviated septum, they may decide to correct a cosmetic problem at the same time. In this case, their health insurance only covers the cost of the portion of the procedure that addresses the medical issue. While it may be hard to predict exactly what insurance will cover and what the patient’s responsibility will be, it may be helpful to request an itemized breakdown of the projected cost of the procedure.

Comprehensive Health Insurance Coverage with Nevada Insurance Enrollment

Even medically necessary surgeries that are covered by health insurance can be a significant expense. At Nevada Insurance Enrollment, our health insurance agents help you review your policy to determine what you should expect to pay for medically necessary rhinoplasty. We can also help you compare health insurance policies across several companies to help you make educated decisions regarding your coverage.

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Is Health Insurance Worth The Cost?

If you experience a more extensive medical emergency and require hospitalization, hospital bills may quickly become a burden. A three-day stay, for example, could set you back about $60,000 depending on what tests are ordered and what happens during your stay.

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What is Co-Insurance?

Co-insurance means two parties will be paying for the bill. “Co” means joint, mutual, two, or more. The health insurance company will usually pay the larger amount (example 70%) and you as the member will usually pay the lesser amount (example 30%). This would be considered co-insurance 70/30. This (co-insurance) usually happens AFTER the deductible is met.

Health Insurance Coverage Effective DatesPin

Health Insurance Coverage Effective Dates

Once you have picked a health insurance policy and paid your first month’s premium, you probably expect your coverage to begin immediately. However, depending on when you enrolled and under what circumstances, you may have several weeks before your health insurance coverage takes effect.

 

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Things Potentially NOT Covered By Your Health Insurance

To be fair, in recent years, health insurance companies have made strides towards transparency. If you have an ACA-compliant plan, there are many services that your health insurance is legally required to cover, taking some of the guesswork out of budgeting for health expenses.

Medical Loss Ratio

This Medical Loss Ratio states that when a family or individual buys a medical plan, 80% of every dollar collected and paid to an insurance company MUST pay medical claims/research. So that leaves the insurance company to pay ALL of their expenses with the remaining 20%. .20 cents on the dollar for their employees, buildings, broker costs, etc.

Are Fertility Services Covered by Health Insurance?

Even if you live in a state that requires health insurance coverage for fertility treatments, there may be certain requirements that you have to meet to have services covered. For example, if you have unexplained infertility, you might only qualify for in vitro fertilization after a period of time or a specified number of in-vitro cycles.

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