Cross-Sectional Analysis of Insurance Coverage for Functional Septorhinoplasty in the United States.

[BACKGROUND] The benefits and cost-effectiveness of functional septorhinoplasty have been previously demonstrated. However, reimbursement for functional septorhinoplasty by health insurance companies remains inconsistent. The purpose of this study was to define the current state of insurance coverage for functional septorhinoplasty.

[METHODS] A cross-sectional analysis of insurance reimbursement for functional septorhinoplasty in the United States was designed. The top 3 insurance companies per state based on market share data maintained by the Kaiser Family Foundation were included. Established medical policies were gathered from insurance company websites and phone interviews, and descriptive statistics were performed. Primary outcomes included the level of and criteria for coverage.

[RESULTS] This study included 67 insurance companies representing 88% of the U.S. market share. Most insurance companies offered coverage with preauthorization for rhinoplasty (61%) and septoplasty (55%). However, some companies determined coverage on a case-by-case basis (rhinoplasty, 25%; septoplasty, 22%), whereas others had no defined policy for coverage (rhinoplasty, 14%; septoplasty, 23%). The most common criteria for coverage of rhinoplasty included nasal deformity secondary to trauma (98%), congenital anomaly (88%), and other disease (85%). The most common criteria for coverage of septoplasty included nasal obstruction (49%), septal deviation (46%), and recurrent sinusitis (40%).

[CONCLUSIONS] Functional septorhinoplasty offers significant improvement in nasal breathing and quality of life, yet disparate insurance coverage criteria limit patient access to care. Patient-reported outcome measures data will be essential to define an evidence-based list of standardized criteria for insurance coverage of functional septorhinoplasty moving forward.