Rhinoplasty and Insurance

[WG mom]

Has anyone had rhinoplasty for saddle nose that was covered by insurance? My daughter has been in “remission “ for about 3 years, although still takes about 3mg prednisone daily. Her doc has recently cleared her for the surgery.
Once Covid is in the rear view mirror, she’d like to have the procedure (she’s 31 and was diagnosed at 23).
Her policy claims it is cosmetic and won’t cover it. She’s told it would cost nearly $30,000 out of pocket. Yikes.
Thoughts. Advice?
Thank you.

[drz]

Has anyone had rhinoplasty for saddle nose that was covered by insurance? My daughter has been in “remission “ for about 3 years, although still takes about 3mg prednisone daily. Her doc has recently cleared her for the surgery.
Once Covid is in the rear view mirror, she’d like to have the procedure (she’s 31 and was diagnosed at 23).
Her policy claims it is cosmetic and won’t cover it. She’s told it would cost nearly $30,000 out of pocket. Yikes.
Thoughts. Advice?
Thank you.

Such decisions can be appealed but success depends upon how good the insurance company is and what documentation the surgeon and treating doctors provide. If they claim the operation is "medically necessary" and not for cosmetic reasons you may have a good chance of getting it covered. And it may pay to shop around for second opinions. A doctor at Mayo wouldn't do my BAHA surgery for Medicare rates and told me it would not be covered so they wanted $60,000 to pay for it. The doctor at U of MN said no problem with coverage and he was very willing to do it for Medicare rates and it was fully covered at their rates with no cost to me.

[WG mom]

WOW! $60,000?
Obviously she has employer based insurance and not Medicare. Guess she’ll have to see if her doc can somehow justify the procedure. Don’t know surgeons name, but she was told the best surgeon for this is in Chicago.
Thanks for your response.

[me2]

I wonder if the Vasculitis Foundation would have some ideas about how people have been successful getting this paid for in the past? It's a fairly common surgery in our group. I'll bet they have some stories. Couldn't hurt to ask.

[WG mom]

I wonder if the Vasculitis Foundation would have some ideas about how people have been successful getting this paid for in the past? It's a fairly common surgery in our group. I'll bet they have some stories. Couldn't hurt to ask.
Thank you.
Great suggestion.

[me2]

I had one more idea for you . It may or may not help with this issue but certainly could help for insurance issues in the future.
Many years ago I was extremely ill and my insurance was refusing to pay for life saving treatment for me and I found a book by a woman Laurie Todd. Her book forever changed how I look at insurance companies and my methods of dealing with them . I think it should be required reading for anyone who has insurance. I first got it from the library but ended up buying a copy so I could loan it out to people myself.
She is known as The Insurance Warrior. Here is a good article about her - https://www.statnews.com/2016/04/25/insurance-warrior/

Learn what really matters to the insurance companies and some fantastic ideas about how to make your best case with them to get coverage.