Ok so I know that no one can answer this with absolute certainty unless they work for my health insurance company, but I figured I would give it a shot. So I was a serious gymnast in my adolescence, but I also have a connective tissue disease, so when I broke my nose in gymnastics, it did not heal back correctly at all. So not only do I have a double deviation of my septum now, I also have scar tissue inside my nose, and the bone and cartilage did not come back together seamlessly. It’s been bigger in general size and I have had a small hump on the bridge ever since that accident. I have about a 40% blockage on one side and 100% on the other. The first time I had x rays of my skull was with my pediatrician, who documented my broken nose, and that was like 15 years ago. Since then i have been told by 4 different doctors, (including my pediatrician, my pcp as an adult, my jaw surgeon, my dentist and an ENT) that I have needed this surgery. My question is, from what you can tell in the wording here (i also included it below) will my insurance cover the entire functional rhinoplasty since there was cosmetic alteration that happened directly because of the accident/injury, or will they only cover the septum and not the correction of the structural damage?
Cosmetic Surgery or Reconstructive Surgery: Cosmetic or Reconstructive surgery, which in the opinion of us is, performed to alter an abnormal or normal structure solely to render it more esthetically pleasing where no significant anatomical functional impairment exists. The following are examples of non- covered services: Rhinoplasty and associated surgery; Rhytidectomy or rhytidoplasty; Breast augmentation/implantation; Blepharoplasty without visual impairment; Breast reduction which is not medically necessary, as determined by us; Otoplasty; Skin lesions without functional impairment, suspicion of malignancy or located in area of high friction; Keloids; Procedures utilizing an implant which does not alter physiologic function; Treatment or surgery for sagging or extra skin; Liposuction; Mon-medically necessary removal or replacement of breast implants, as determined by us. Cosmetic or Reconstructive surgery performed, in our opinion, to correct injuries that are the result of accidental injury is a Covered Service. In addition, this exclusion does not apply to breast recon- struction incidental to a covered mastectomy for either the breast on which the mastectomy has been performed or for surgery and reconstruction of the other breast to produce a symmetrical appearance. Reconstructive surgery incidental to birth abnormali- ties of a Covered dependent is limited to the medically necessary care and treatment of medically diagnosed congenital defect and birth abnormalities of a newborn, adopted child or child placed for adoption. Surgery will be covered past the newborn period if medically necessary and medical criteria are met.
submitted by /u/Reasonable-Argument6
[link] [comments]Ok so I know that no one can answer this with absolute certainty unless they work for my health insurance company, but I figured I would give it a shot. So I was a serious gymnast in my adolescence, but I also have a connective tissue disease, so when I broke my nose in gymnastics, it did not heal back correctly at all. So not only do I have a double deviation of my septum now, I also have scar tissue inside my nose, and the bone and cartilage did not come back together seamlessly. It’s been bigger in general size and I have had a small hump on the bridge ever since that accident. I have about a 40% blockage on one side and 100% on the other. The first time I had x rays of my skull was with my pediatrician, who documented my broken nose, and that was like 15 years ago. Since then i have been told by 4 different doctors, (including my pediatrician, my pcp as an adult, my jaw surgeon, my dentist and an ENT) that I have needed this surgery. My question is, from what you can tell in the wording here (i also included it below) will my insurance cover the entire functional rhinoplasty since there was cosmetic alteration that happened directly because of the accident/injury, or will they only cover the septum and not the correction of the structural damage? Cosmetic Surgery or Reconstructive Surgery: Cosmetic or Reconstructive surgery, which in the opinion of us is, performed to alter an abnormal or normal structure solely to render it more esthetically pleasing where no significant anatomical functional impairment exists. The following are examples of non- covered services: Rhinoplasty and associated surgery; Rhytidectomy or rhytidoplasty; Breast augmentation/implantation; Blepharoplasty without visual impairment; Breast reduction which is not medically necessary, as determined by us; Otoplasty; Skin lesions without functional impairment, suspicion of malignancy or located in area of high friction; Keloids; Procedures utilizing an implant which does not alter physiologic function; Treatment or surgery for sagging or extra skin; Liposuction; Mon-medically necessary removal or replacement of breast implants, as determined by us. Cosmetic or Reconstructive surgery performed, in our opinion, to correct injuries that are the result of accidental injury is a Covered Service. In addition, this exclusion does not apply to breast recon- struction incidental to a covered mastectomy for either the breast on which the mastectomy has been performed or for surgery and reconstruction of the other breast to produce a symmetrical appearance. Reconstructive surgery incidental to birth abnormali- ties of a Covered dependent is limited to the medically necessary care and treatment of medically diagnosed congenital defect and birth abnormalities of a newborn, adopted child or child placed for adoption. Surgery will be covered past the newborn period if medically necessary and medical criteria are met. submitted by /u/Reasonable-Argument6 [link] [comments]Read Morer/HealthInsurance