Rhinoplasty (nosejob or external nose surgery) is usually a cosmetic procedure. Patients frequently believe or want their rhinoplasty to be covered by insurance. While this is not common, it may be covered if the deformity of the nose is causing breathing problems. Just saying that you have trouble breathing through your nose, however, is not sufficient ‘medical evidence’ by health insurance standards. The breathing problem must be determined if its correction is medically necessary. There are strict criteria for that determination and they are as follows:
– When a rhinoplasty is being done to correct an external deformity of the nose in patients born
with cleft lip and palate and other craniofacial birth defects. These birth defects are associated
with a lot on internal and external anatomic deformities that give all of them well known
breathing problems.
– To correct chronic breathing problems through the nose as a result of middle vault collapse
(vestibular stenosis or collapsed internal valves…a pinching in the middle third of the
external nose) due to an accident, tumor, or a birth defect. The following clinical criteria all
need to be met however to qualify.
1) Difficulty breathing through one’s nose, and
2) The nasal deformity must be able to be seen in pictures, and
3) The breathing obstruction through any one nostril is
greater than 50%. and
4) The breathing problem can not be caused by an internal problem
of a deviated septum or enlarged turbinate bones.
In short, only external nasal deformities caused by a cleft/craniofacial birth defect or middle vault collapse will qualify. Both can be well evidenced in photographs which are a required part of the predetermination process.
Dr. Barry Eppley
Indianapolis, Indiana