One of the first questions patients ask when planning rhinoplasty is whether insurance will cover the procedure. The answer depends on your goals: Cosmetic rhinoplasty, performed only to change the nose’s appearance, is never covered. Procedures that correct breathing problems or structural issues may qualify if medical necessity is documented.
At Primera Plastic Surgery* in Lake Mary, double board-certified facial plastic surgeon Dr. Edward Gross has more than 25 years of experience correcting both cosmetic and functional nasal concerns. He is well known throughout the Orlando area for performing complex, referral-based procedures that improve not only how the nose looks, but how it works.
Cosmetic vs. Functional Rhinoplasty: Why It Matters for Insurance Coverage
Insurance companies make a clear distinction between cosmetic and functional procedures. Here’s what that means for coverage:
- Cosmetic rhinoplasty focuses on improving appearance and is never covered.
- Functional rhinoplasty restores airflow and corrects structural problems such as a deviated septum or nasal valve collapse. These procedures may be eligible for coverage when you have a proven medical necessity.
What Is Functional Rhinoplasty?
Functional rhinoplasty focuses on restoring proper airflow and nasal structure rather than enhancing aesthetics. In many cases, it is performed to correct:
- Nasal valve collapse
- Deviated septum
- Nasal trauma or injury
- Breathing difficulties
- Recurrent sinus issues
- Internal scarring or previous surgical complications
Septoplasty, a type of functional rhinoplasty, straightens the nasal septum—the wall of cartilage and bone dividing the nostrils.
Discover how functional rhinoplasty can help people live, feel, and breathe better.
When Will Insurance Cover Rhinoplasty?
Insurance providers may cover functional rhinoplasty or septoplasty if the procedure is medically necessary and meets the plan’s clinical guidelines. Requirements often include:
- Documented difficulty breathing through the nose
- Failure of nonsurgical treatments, such as nasal sprays
- CT scan or nasal endoscopy showing anatomical obstruction
- Recommendation from a qualified specialist
Will My Insurance Cover Septoplasty?
Septoplasty, performed to correct a deviated septum, is a more commonly approved nasal procedure. A deviated septum can lead to blocked airflow, chronic congestion, frequent sinus infections, snoring, and sleep disturbances.
If symptoms are consistent with obstruction and medical management has failed, many insurance plans will cover the cost of this procedure.
Important Insurance Policy Note
Primera Plastic Surgery does not work directly with insurance companies and does not submit insurance claims on behalf of patients. All rhinoplasty and septoplasty procedures at our practice are self-pay.
If you believe your procedure may qualify as medically necessary, you may contact your insurance provider directly to determine if any reimbursement is available. We can provide documentation for your personal submission upon request, but all financial arrangements are your responsibility.
Can I Combine Cosmetic and Functional Rhinoplasty?
Yes, it’s common to combine cosmetic and functional rhinoplasty. Patients who suffer from both cosmetic concerns (such as a dorsal hump or droopy tip) and functional issues often choose to address both in a single surgery.
Because Dr. Gross is double board-certified in facial plastic surgery and otolaryngology (ENT), he is uniquely qualified to handle complex cases where aesthetics and function intersect.
Does Insurance Cover Combined Cosmetic and Functional Rhinoplasty?
Insurance providers require evidence of medical necessity before approving coverage. In these combined procedures:
- Insurance may cover the internal or structural portion of the surgery (e.g., septoplasty or nasal valve repair).
- Insurance does not cover cosmetic improvements, such as tip refinement, nostril reshaping, or hump reduction.
You’ll recover from both procedures at once, avoiding the cost and downtime of 2 separate surgeries.*
What Insurance Does Not Cover
It’s important to understand that insurance will not cover any rhinoplasty procedure performed strictly for cosmetic purposes. This includes:
- Nose reshaping for aesthetic enhancement only
- Tip refinement or nostril narrowing without functional obstruction
- Removal of dorsal hump for profile correction
- Any procedure intended to improve facial symmetry alone
Insurance also does not cover computer imaging or consultations for cosmetic purposes. If you’re considering rhinoplasty for cosmetic reasons, we’ll provide a transparent quote and information about financing options. Because Primera Plastic Surgery does not work with insurance companies, all cosmetic and functional procedures require direct payment from patients.
Getting a Cost Estimate
To receive a personalized rhinoplasty price quote—you’ll need to schedule a consultation with Dr. Gross.
Your consultation includes:
- Physical examination and evaluation of nasal structure
- 3D computer imaging to visualize potential results
- A personalized treatment plan with a detailed cost estimate
We also offer financing through CareCredit®, with flexible payment plans starting as low as $236/month.
Why Choose Dr. Gross for Functional Rhinoplasty?
Dr. Gross is one of the most experienced rhinoplasty surgeons in Central Florida. His advanced credentials and reputation for excellent outcomes make him a top choice for both cosmetic and functional nose surgery.
- Double board-certified in facial plastic surgery and otolaryngology
- Over 25 years of experience performing septoplasty and rhinoplasty
- Trusted by referring ENTs, primary care doctors, and plastic surgeons
- Known for combining aesthetic balance with restored breathing
Whether you’re seeking to correct a medical concern, refine the shape of your nose, or both, Dr. Gross can help you breathe easier and feel more confident.
Schedule Your Consultation
If you’re wondering whether rhinoplasty or septoplasty is right for you, we can help you find answers. Call (407) 333-3040 or request your consultation online to meet with Dr. Gross in our Lake Mary office and take the next step toward clarity—and better breathing.
*Please note that Primera Plastic Surgery does not accept insurance and requires payment at the time of service.
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