If you’re struggling to breathe easily or suffer from constant nasal congestion, deviated septum surgery, also known as septoplasty, might be your best path to relief. But there’s one pressing question that stops many people from moving forward: does insurance cover deviated septum surgery?
The good news is, yes — in many cases, insurance will cover septoplasty, especially when it’s medically necessary. Let’s walk through everything you need to know, in clear, simple language, so you can breathe a little easier — both literally and financially.
What is a Deviated Septum?
Your septum is the thin wall between your nostrils. When it’s off-center or crooked, it’s called a deviated septum. This can happen naturally or from an injury.
A severely deviated septum can block airflow, causing:
- Trouble breathing through one or both nostrils
- Frequent sinus infections
- Nosebleeds
- Snoring or sleep apnea
- Headaches
It’s more than a cosmetic issue. It can truly affect your quality of life.
What is Septoplasty and How Does It Help?
Septoplasty is a surgical procedure to straighten the septum. It’s typically done by an ENT (Ear, Nose, and Throat) specialist.
The goal? Improve airflow through your nose. That means better sleep, fewer infections, and easier breathing.
Is Septoplasty Medically Necessary?
Sometimes, people get a septoplasty for cosmetic reasons. But when the surgery is done to fix breathing problems, it’s usually considered medically necessary.
That’s the key phrase your insurance provider wants to hear. Medical necessity means the surgery is needed to treat a health problem — not just improve appearance.
Does Health Insurance Cover Septoplasty?
In most cases, yes. If your doctor confirms that your deviated septum causes significant health issues, your insurance provider is likely to cover part or all of the cost.
Major insurers like Aetna, Cigna, Blue Cross Blue Shield, and UnitedHealthcare generally include septoplasty in their policies when it’s medically required.
How Insurance Providers Decide What’s Covered
Insurance companies look at:
- Your medical history
- Doctor’s notes
- Symptoms and diagnosis
- Results from imaging tests or nasal endoscopy
- Whether other treatments were tried first
If all signs point to a health problem caused by your septum, you’re likely to get coverage approval.
Cosmetic vs Functional: Know the Difference
Insurance will not pay for cosmetic surgery. So, if you’re just getting a nose job (rhinoplasty) to change how your nose looks, you’ll pay out of pocket.
But if you’re combining rhinoplasty with septoplasty, your insurance may still cover the functional part. Make sure your ENT and plastic surgeon document everything clearly.
What to Expect When Getting Insurance Approval
The approval process can feel overwhelming. But staying organized helps. Here’s what to do:
- Visit an ENT specialist for a full exam
- Undergo tests (nasal endoscopy or CT scans)
- Document all symptoms and treatments
- Ask your doctor to write a letter of medical necessity
- Submit everything to your insurance company for pre-authorization
Tip: Call your insurance provider and ask about what’s needed for approval. Be proactive.
How Much Does Septoplasty Cost With Insurance?
When covered, your main costs might include:
- Deductible
- Co-insurance
- Co-payments
Without insurance, septoplasty can cost between $6,000 and $13,000. With insurance, you may only pay a few hundred dollars depending on your plan.
What If Insurance Denies the Claim?
Sometimes, insurance companies deny the request. Don’t panic — it doesn’t mean the end.
- Ask why it was denied
- Request a written explanation
- Work with your doctor to submit an appeal
- Provide more evidence or updated documents
Appeals often succeed when the paperwork is strong.
Patient Stories: Real Results and Relief
Many patients who’ve had septoplasty covered by insurance say it changed their lives. They breathe better, sleep more soundly, and experience fewer sinus problems.
Their advice? Be persistent. Get the right documentation. And trust your doctor to guide the process.
Quick Checklist for Septoplasty Insurance Approval
- See an ENT for diagnosis
- Get a nasal endoscopy or imaging test
- Try other treatments first (like sprays or meds)
- Collect medical records
- Ask for a letter of medical necessity
- Call your insurance to understand requirements
- Submit pre-authorization paperwork
Doing all of this upfront can save stress — and speed up approval.
Conclusion
Getting a deviated septum fixed isn’t just about appearance — it’s about health. If you’re asking, does insurance cover deviated septum surgery, the answer is: usually yes, if it’s medically necessary. Always consult with your doctor and insurance provider to be sure.
And if you’re learning more about your health coverage, you might also wonder what does insurance loss reported mean or even can I have 2 dental insurance plans. These are smart questions that show you’re taking charge of your health and finances.
You deserve to breathe better, sleep easier, and feel great. And with the right steps, your insurance can help make that happen.
FAQs About Does Insurance Cover Deviated Septum Surgery
Is deviated septum surgery covered by insurance if I have breathing issues?
Yes. If your breathing is affected, and a doctor confirms that a deviated septum is the cause, insurance will usually consider septoplasty medically necessary and provide coverage.
Do I need a referral from a primary care doctor for septoplasty coverage?
Often, yes. Many insurance plans require a referral to see an ENT specialist. Check your specific plan’s referral rules before scheduling your appointment.
Can insurance cover both septoplasty and rhinoplasty together?
Insurance typically only covers the septoplasty part if it’s for medical reasons. If rhinoplasty is done for cosmetic reasons, you’ll pay for that portion yourself. But when the two surgeries are combined, you may save money on anesthesia or facility fees.
What documentation do I need to prove medical necessity for septoplasty?
You’ll need medical records, test results (like CT scans), symptom history, and a letter from your ENT specialist explaining how your condition affects your health.
Will insurance cover a revision septoplasty if the first surgery didn’t help?
Possibly. If symptoms persist and your ENT confirms that a revision is necessary, insurance may approve it. You’ll need to show why the second surgery is required and what improvements are expected.
