When is surgery “cosmetic” or “medically necessary”?

I was diagnosed with a deviated septum and will be having surgery next month.  I am very excited to be able to breathe better.  The surgery will also reshape my nose a bit.  Will I have to pay for this surgery because it is partly “cosmetic”?

Ahead by a Nose

Dear Ahead by a Nose,

The major reason for the surgery is to correct the deviated septum; so, it is considered “medically necessary” and would be covered by your health insurance.

You are correct that cosmetic surgery is generally not covered by health insurance.  There are exceptions.  For example, if your nose had been injured in an accident, surgery to fix it would be considered medically necessary and would be covered.  Another example is breast reconstruction surgery after a mastectomy.

You can always double check with your insurer to find out how much they will pay toward your surgery.  You may have to pay a certain amount before your plan pays – called a “deductible” or “co-pay”.


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Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.