this is the first time I have insurance and I don´t understand how it works very well, Can you help me?

Question

I want to get a nose job and I was wondering how the insurance work in this cases.
I know it probably won´t cover the whole surgery, but I was wondering if it will cover the hospitalization time, or some stuffs like that??

Does anybody know how this things work?

My insurance is UPMC Health Plan

THANK YOU!!

Answer 1

It depends on what you mean by "nose job".

If you just don't like the shape of your nose - want plastic surgery to improve your looks - health insurance will not pay for that. Health insurance does not pay for elective procedures.

If you have a deviated septum and need to have surgery to correct that so you can breath better (does not change the look of your nose) - then health insurance will usually pay for that. You have to see an Ear, Nose, & Throat dr (ENT). They will order a CT Scan - and if determine that you have an obstruction - they will contact your health insurance for authoriztion.

Answer 2

As most experts indicated, cosmetic surgeries are generally excluded items from most health plans. The carrier will however cover these items in post-trauma or post-surgical situations.

In my travels I have only seen these covered under two circumstances...

1. Deviated Septums- Often an "ENT" will have to conduct some reconstruction afterwords and the carriers are friendly to this.

2. Accident related- Keyword: "Without third party liability"

If you want a no-frills answer see a specialist and have them generate you a letter of medical necessity for the surgery. Then submit a pre-determination to the carrier for consideration. At that time, the carrier will provide their benefit logic to the claim prior to services being rendered.

Also, ask the carrier if you can utilize the contract rates when obtaining non-medically necessary services from a contracted provider. This can save you significant amounts of money.

Answer 3

If you are getting a nose job for purely cosmetic reasons, then nothing related to the surgery will be covered by your health insurance. (Not the hospitalization, not the doctor bills...nothing. Its even possible that you wouldn't have coverage for any complications.)

If there's a medical reason for your nose job, you may be able to get prior authorization from your insurance company. But be forewarned that there are very specific medical criteria that you'd have to meet for your insurance company to consider the nose job medically necessary. If you just want it done because you don't like the way your nose looks, then that doesn't count - the entire expense will be out of your pocket.

Answer 4

Usually , unless it was broken in an accident and you are impaired ,
It will be considered cosmetic and nothing will be covered .
Most nose jobs are paid 100% by the person .

>

Answer 5

Insurance does not normally cover ellective or plastic surgery (any of it).

Answer 6

It won't cover ANY of it - cosmetic surgery isn't covered at all. Sorry.