Can insurance help pay for your nose job? It’s one of the most common questions we hear at The Naderi Center for Plastic Surgery and Dermatology, and the answer might surprise you.
If you’re considering rhinoplasty, and you also have trouble breathing through your nose, you may qualify for what’s called functional nasal surgery, and that part of the procedure can often be billed to your health insurance. This means you could potentially save hundreds or even thousands of dollars on your overall procedure.
The process is more complex than it sounds. Many parts determine if insurance pays, and how much it pays – these parts range from CPT codes to coinsurance, and also include in-network status.
At The Naderi Center, we specialize in both aesthetic and functional nasal surgery, and we’re here to help you understand exactly how it works.
Essential Insurance Insights for Your Rhinoplasty
- Insurance does not pay for cosmetic nose surgery. It may pay for the functional part, like breathing troubles.
- Coverage often applies to procedures such as septoplasty, turbinate reduction, along nasal valve repair.
- When combining cosmetic surgery with functional surgery, they can lower their total out-of-pocket costs.
- Coverage depends on medical necessity, documentation, and insurance approval.
- The Naderi Center handles all insurance coordination to make the process smooth and transparent.
What Is Functional Nasal Surgery?
Functional nasal surgery refers to medical operations that improve a person’s ability to breathe; these operations fix structural problems inside the nose. These problems cause ongoing nasal obstruction, mouth breathing, snoring, or sleep apnea.
Common types of functional nasal surgery include:
- Septoplasty – straightening a deviated septum
- Turbinate reduction – reducing the size of the turbinates (structures inside the nose that regulate airflow)
- Nasal valve repair / Vestibuloplasty – opening the nasal valves for better airflow
These procedures are often performed at the same time as a cosmetic rhinoplasty, but they serve a different purpose, and that’s where insurance may come in.
What’s the Difference Between Cosmetic and Functional Nose Job?
| Feature | Cosmetic Rhinoplasty | Functional Nasal Surgery |
|---|---|---|
| Covered by Insurance? | No | Often yes |
| Purpose | Aesthetic change | Improve breathing |
| Examples | Narrowing the nose tip, removing the hump | Septoplasty, turbinate reduction |
| CPT/ICD-10 Coding Required? | Not applicable | Yes |
| Doctor Referral Required? | Optional | Often required |
How Insurance Coverage Works for Functional Procedures
Insurance does not cover cosmetic nose reshaping. People consider this surgery an elective choice. But when a doctor performs a medical procedure at the same time, such as septoplasty or turbinate reduction, your insurance plan pays for that part of the surgery.
CPT codes, or Current Procedural Terminology codes, classify and bill medical procedures – these codes pair with ICD-10 diagnosis codes. The diagnosis codes explain why a procedure is necessary, as for chronic nasal obstruction or a deviated septum.
If approved, insurance may help cover:
- A portion of the surgeon’s fee (for the functional component)
- A portion of the anesthesia fee
- A portion of the operating room/facility fee
In some cases, this can bring the patient’s total out-of-pocket cost down by 15% to 20%—a significant savings.
PPO vs. HMO: Does Your Insurance Plan Type Matter?
Your insurance plan type greatly affects what the plan covers and how easily a claim gets approved.
- PPO (Preferred Provider Organization) plans usually give more options. You see specialists, like Dr. Shervin Naderi without a referral. In-network billing is often simpler.
- HMO (Health Maintenance Organization) plans usually require:
- A referral from your primary care physician
- Pre-authorization for specialist visits and procedures
- Use of a narrow network of approved providers
The Naderi Center’s team checks your plan details beforehand. This helps you avoid unexpected restrictions – it also helps you get the most from your benefits.
Why Choose The Naderi Center?
Dr. Shervin Naderi is one of the most trusted names in rhinoplasty and functional nasal surgery. He is a rare double board-certified facial plastic surgeon and ENT (Ear, Nose & Throat) specialist with over two decades of experience. Rhinoplasty is the only surgery he performs, and he’s recognized nationwide for his expertise in both the cosmetic and medical sides of nose surgery.
Most importantly, our office is extremely experienced in working with insurance, especially when it comes to billing and coding for procedures like septoplasty.
Many practices simply hand you a bill and send you on your way. At The Naderi Center, we walk you through every step of the process so there are no surprise bills, no missed opportunities to use insurance, and no unanswered questions.
Choose a nationally recognized expert
Dr. Naderi performs nose surgery, combining artistry and medical precision.
Understanding Insurance Terms That Impact Your Cost
Let’s face it—most people don’t fully understand how their health insurance works. Here are a few critical terms that can affect your cost:
- Deductible – The amount you must pay each year before your insurance starts paying.
- Coinsurance – After your deductible is met, you may still owe a percentage of the bill (often 10–30%).
- Copayment – A fixed dollar amount for specific services, usually due at the time of the visit.
- Out-of-pocket maximum – The total amount you’ll ever have to pay in a given year. After you hit this cap, your insurance pays 100%.
- In-network vs. Out-of-network – Using an in-network provider saves you money. Out-of-network services usually come with higher deductibles and coinsurance, and sometimes no coverage at all.
At The Naderi Center, we work hard to ensure that both Dr. Naderi and the surgical facility are in-network with your insurance plan whenever possible.
We Handle the Insurance, So You Don’t Have To
Dealing with insurance companies is never easy. That’s why we have a dedicated team of insurance specialists who have been with us for over a decade. They know how to:
- Verify your benefits
- Get prior authorizations when required
- Schedule peer-to-peer physician reviews
- Submit clean, accurate claims
- Follow up and fight for proper reimbursement
We do everything possible to make the process smooth and transparent, for your peace of mind and your wallet.
Insurance Limitations: Not Every Patient Qualifies
It’s important to note that not everyone qualifies for insurance coverage. In order for the functional part of surgery to be covered, your medical evaluation must show a clinical need. That’s why Dr. Naderi performs a detailed physical exam and reviews your medical history during your consultation.
If your symptoms and anatomy meet insurance criteria, we will absolutely encourage you to take advantage of your benefits.
Why Transparency Matters
One of the biggest frustrations patients face in the surgical world is not knowing what they’ll owe until the bills start rolling in. At The Naderi Center, we prioritize price transparency. Before your surgery is even scheduled, you’ll know:
- What portion is cosmetic (not covered)
- What portion may be billed to insurance
- What your estimated costs will be based on your plan and your benefits
This is a level of service most practices simply don’t offer.
Take the Next Step for Functional Rhinoplasty
If you consider rhinoplasty and also have breathing problems, you could qualify for combined cosmetic plus functional nose surgery. The Naderi Center evaluates your anatomy, reviews your symptoms, checks your insurance benefits, and then creates a specific plan. This plan supports your health also your goals.
Schedule your consultation today and let our experienced team guide you through a smooth, transparent process—while delivering beautiful, breathable results. You can visit us in our Reston and Chevy Chase offices.
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