Does Insurance Cover Surgery for a Deviated Septum?

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Bliss believes in empowering you with clarity so you can focus fully on your wellness journey. To make good on our promise for clarity, we’re going to answer the question “Does insurance cover rhinoplasty?” and specifically, how it relates to the procedure.

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What is a Deviated Septum & Why People Seek Correction

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A deviated septum means the wall (septum) between your two nasal passages is off-center or crooked, which can obstruct airflow, contribute to chronic congestion, snoring, nosebleeds, or sleep issues.

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That’s why so many people, men and women alike, seek correction to reclaim easier breathing, improved sleep, and comfort. It’s important to clarify the difference between the two commonly referenced surgeries: the functional vs cosmetic approach.

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1. Septoplasty: surgery to correct the septum itself (for function).
2. Rhinoplasty: surgery primarily to alter the shape or appearance of the nose (for aesthetics).

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Medical vs. Cosmetic Rhinoplasty

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When the primary goal is to restore or improve nasal function (breathing, airflow, sinus drainage) rather than purely appearance, a medical rhinoplasty is considered medically necessary. When the goal is to change or refine the nose’s appearance (bridge, tip, width) without substantial functional impairment, a cosmetic rhinoplasty is the option available, elective, and typically deemed aesthetic only. 

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In short: because insurance is geared toward medically necessary care, cosmetic procedures are usually not covered, while functional ones may be. 

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When Insurance Covers Rhinoplasty or Septoplasty

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Understanding whether deviated septum insurance coverage (or functional rhinoplasty coverage) can be applied to your surgery is a critical part of the aesthetic journey. Let’s break down the requirements for septoplasty vs rhinoplasty insurance. 

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Coverage for a deviated septum

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If a deviated septum causes significant symptoms (nasal obstruction, recurrent sinus infections, sleep disruption), many insurers will cover septoplasty as medically necessary. 

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Coverage for the rhinoplasty component

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If rhinoplasty is performed in conjunction with functional correction (for example, septoplasty + cosmetic change = “septorhinoplasty”), insurers may cover the functional portion but not the cosmetic portion.

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Typical insurer criteria

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Insurers often look for:

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• Documented breathing obstruction or nasal airway issues due to septal deviation.

• Evidence of failed conservative treatments (nasal sprays, decongestants, etc) before surgery.
• Imaging (CT or other) demonstrating structural deviation.
• In some cases, trauma, congenital deformity, or external nasal structure damage.

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The Approval Process For Insurance

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Pre-authorization

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Before scheduling surgery, you’ll typically need pre-approval from your insurer. This is especially important for functional rhinoplasty or combined procedures.

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Submit medical necessity documentation

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Your surgeon / ENT should provide:

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• A diagnosis of a deviated septum or nasal obstruction
• A report of symptoms (breathing trouble, snoring, sinus infections)
• Results of conservative treatment attempts
• Imaging (CT, nasal endoscopy) if required
• The proposed CPT (procedure) codes to the insurer

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Common coding

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While coding may vary by insurer/region, for example, septoplasty often has distinct CPT codes, and combinational procedures (septorhinoplasty) may have separate coding lines. It’s wise to ask your surgeon’s billing team to verify which codes will be used and whether the insurer recognizes them.

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Out-of-Pocket Costs

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Even when insurance covers part of the surgery, you may still face out-of-pocket expenses:

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• Surgeon’s fees for the cosmetic portion (if rhinoplasty is combined).
• Anesthesia, facility, or hospital fees may not be fully covered. Some insurance will cover the functional portion, but not cosmetic fees.
• Deductibles, co-pays, and coinsurance can apply even for the covered portion.

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If you decide to add aesthetic enhancements (tip refinement, bridge reshaping), that incremental cost is likely your responsibility.

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Combining functional + cosmetic: while you may save relative to doing two separate surgeries, you’ll likely still see separate billing (functional via insurance, cosmetic via self-pay). 

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Things to Remember

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• Insurance may cover surgery for a deviated septum when it’s medically necessary (i.e., breathing/obstruction issues).
• Insurance typically will not cover a rhinoplasty performed purely for cosmetic reasons.
• If you plan a combined procedure (functional + cosmetic), your insurer may cover the functional portion, and you pay the cosmetic portion.
• Your odds of coverage improve with strong documentation: clear diagnosis, failed conservative treatments, imaging, and specialist evaluation.
• Always check your specific plan details; benefits vary widely by insurer, region, and policy.

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Talk with your surgeon’s insurance-benefits team early: ask which portion is billed to insurance, which is out-of-pocket, what CPT/diagnosis codes will be used, and whether your surgeon is in-network. 

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Ready to take the next step? At Bliss, we’re committed to guiding you through this journey with transparency, innovation, and empathy, so you feel confident, cared for, and empowered every step of the way. If you’d like help understanding your insurance options, more about the procedure, its recovery timeline, or simply want to schedule a consultation, we’re here for you.