Does Insurance Cover Perforated Septum and What to Expect

A perforated septum can be a painful and concerning condition, but understanding what to expect can help alleviate some of the stress. Most cases of perforated septum are caused by a deviated septum, which is a common condition that affects about 80% of people.

You may be wondering if insurance will cover the costs of treatment. Fortunately, many insurance plans cover the costs of septoplasty, a surgical procedure to repair a deviated septum. This includes Medicare and many private insurance providers.

The costs of treatment can vary depending on the severity of the condition and the type of procedure needed. On average, a septoplasty can cost anywhere from $3,000 to $15,000.

A perforated septum can be a serious medical condition that requires immediate attention. It occurs when a hole or tear forms in the thin wall of cartilage and bone that separates the two sides of the nasal passages.

The severity of a perforated septum can vary, but it often results from trauma, such as a blow to the nose, or from long-term damage from breathing through the mouth.

Symptoms of a perforated septum may include difficulty breathing through the nose, nosebleeds, and a sensation of nasal congestion.

The nasal septum is a wall of tissue that divides the right and left sides of the nose, made up of several bones and cartilage.

It's covered with soft tissue that grows and shrinks to heat, humidify, and purify the air we breathe.

The nasal septum has a natural cycle, where every 2 to 6 hours one side of the nose swells while the other side contracts.

This nasal cycle allows the open side of the nose to filter air while the other side heals and recovers.

The septum can become damaged, leading to a puncture, which is known as a septal perforation.

A perforated septum is a condition where the thin wall of cartilage and bone that separates the nostrils, called the nasal septum, has holes or tears in it.

The nasal septum is made up of bone and cartilage, and it's a crucial part of the nasal passages, helping to filter, warm, and humidify the air we breathe.

A perforated septum can be caused by a variety of factors, including trauma, infection, or long-term use of nasal strips or other devices that put pressure on the septum.

Trauma to the nose can cause a perforated septum, especially if the injury is severe or repeated.

Infections, such as nasal abscesses or sinusitis, can also cause a perforated septum by weakening the septum and causing holes or tears.

Long-term use of nasal strips or other devices can cause a perforated septum by putting pressure on the septum and causing it to wear down over time.

Symptoms of a perforated septum can include nasal bleeding, difficulty breathing through the nose, and a feeling of nasal congestion or stuffiness.

The severity of a perforated septum can vary, with some people experiencing mild symptoms and others experiencing more severe symptoms.

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The cost of septal perforation repair can vary significantly based on several factors. One of the main factors is the location where the surgery takes place, with urban areas and certain states like California and the Northeast tend to be more expensive than other geographic areas.

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The surgeon's experience and reputation also play a crucial role in determining the cost. More experienced and well-known surgeons may charge higher fees for their services.

The complexity of the procedure is another factor that affects the cost. Septal perforation repair is considered a very complex surgery, which is reflected in the overall cost.

The number of grafts used during the surgery can also impact the cost. This is because using more grafts requires more time, expertise, and materials.

The size of the perforation is another factor that can affect the cost. Larger perforations may require more extensive surgery and more grafts, increasing the overall cost.

The amount of soft tissue coverage needed can also impact the cost. If the surgeon needs to harvest temporalis fascia, this can add to the overall cost of the procedure.

Here are some of the key factors that affect the cost of septal perforation repair:

Insurance coverage for a perforated septum can be complex, but in general, if you can prove that surgery is a medical necessity, insurance will cover it. Medical necessity is defined as health care service that is necessary for the evaluation and treatment of a condition, disease, illness or injury.

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To qualify for insurance coverage, your physician must prove to your healthcare provider that septal perforation repair surgery is medically necessary to help improve or maintain your quality of life. This typically involves demonstrating symptoms such as nose bleeds, whistling sounds, crusting, and other nasal issues.

In some cases, insurance carriers will cover the cost of septal perforation repair surgery, especially if you're experiencing significant medical issues like chronic nasal obstruction, recurrent sinus infections, or sinus headaches. You should check with your insurance carrier to confirm coverage.

Most PPO insurances and Medicare cover septoplasty procedures, which often include septal perforation repair, as a medically necessary treatment. You may only have to pay a co-pay or the deductible portion, depending on your insurance type.

To prepare for septal perforation repair surgery, it's essential to avoid certain medications and supplements that may thin the blood. Stop smoking at least 2 weeks before surgery, as tobacco products can decrease blood flow to the skin and compromise the healing of the surgical site.

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You should also stop all nasal sprays 2 weeks before surgery, except for saline which you can continue. This will help prevent any complications during and after the procedure.

Here are some specific actions to take before your surgery:

To prepare for septal perforation repair surgery, it's essential to avoid certain medications and supplements that may thin the blood. This includes medications like aspirin and supplements like vitamin E.

Stop smoking at least two weeks before surgery, as tobacco products can decrease blood flow to the skin and compromise the healing of the surgical site. I've seen firsthand how smoking can impact the healing process, so it's worth quitting if you're a smoker.

You'll also want to stop all nasal sprays two weeks before surgery, except for saline which you can continue. This will help ensure that your nasal passages are clear and ready for the procedure.

Here are some specific steps to take before your surgery:

Repair costs can vary significantly depending on several factors.

Most septal perforation repair costs are covered by insurance, but it's essential to check if your surgeon is an in-network provider. If they're not, you may still be able to get coverage through out-of-network options.

In general, the facility and anesthesia fees for septal perforation surgery are covered by in-network insurance, as long as the surgery is performed in an ambulatory surgical center.

If you don't have insurance, the cost of septal perforation repair can range from $5,000 to $10,000, depending on whether it's a primary case or a revision procedure. This cost includes anesthesia, facility fees, and the surgeon's fee.

A septoplasty, on the other hand, is often covered by most PPO insurances and Medicare, especially if it's causing significant medical issues.

Here are some factors that can affect the cost of septal perforation repair:

Keep in mind that surgical procedures tend to be more expensive in urban areas, particularly in California and the Northeast.

The repair process for a septal perforation involves a temporary or permanent surgical solution to close the hole. This surgery is typically done under general anesthesia, and the hole is composed of three layers that must each be repaired separately.

There are two main types of approaches to septal perforation surgery: closed and open. The most common type is the closed approach, which involves an internal incision to expose the perforation. The open approach involves making an incision on the outside of the nose and the inside.

The five major steps of a nasal septal perforation repair surgery include anesthesia, incision, dissection, graft harvesting, graft placement, and closure. During the procedure, a plane right over the cartilage is used to expose the cartilage and adjacent bone posteriorly and inferiorly.

To determine if you're a good candidate for septal perforation repair, let's look at the signs and symptoms that indicate you may need this procedure.

Crusting and bleeding are two common indicators that you may be a good candidate for repair. These symptoms can be caused by the perforation allowing air to pass through and dry out the nasal passages.

A whistling sound when you breathe or speak is another sign that you may have a small perforation that needs to be repaired. This sound is often caused by air passing through the perforation.

Large perforations can cause nasal obstruction and/or nasal drainage, making it difficult to breathe or smell. If you're experiencing these symptoms, you may be a good candidate for repair.

Pain and a saddle nose deformity are also signs that you may need septal perforation repair. These symptoms can be caused by the perforation allowing air to pass through and causing the nasal septum to collapse.

To summarize, the following signs and symptoms indicate you may be a good candidate for septal perforation repair:

During the initial consultation, you'll have the opportunity to share your medical and surgical history, including any allergies and medications you're currently taking. This helps your doctor understand your overall health and identify any potential factors contributing to the septal perforation.

You'll be asked about your lifestyle and drug use, as these can sometimes be relevant to the cause of the septal perforation. Your doctor will take this information into consideration when developing a treatment plan.

A physical examination will be performed, including anterior rhinoscopy with a nasal speculum and possibly an endoscope to visualize the septum and nasal structures. This helps your doctor assess the size and location of the septal perforation.

The septal perforation will be measured for size in centimeters, taking note of both the anterior-posterior and inferior-superior dimensions. This information will be used to determine the best course of treatment.

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On the day of your septal perforation repair surgery, you'll need to follow some important instructions to ensure a smooth and safe procedure. Do not eat or drink anything for at least 6 hours before your scheduled surgery.

You'll be under general anesthesia during the procedure, which means you'll have no pain and no memory of the surgery. The entire process will take around 6 hours, with about 3-4 hours of actual surgical time.

Here are the steps you can expect on procedure day: