Does Health Insurance Cover Deviated Nasal Septum Surgery?

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Yes, most health insurance plans in India cover deviated nasal septum surgery, also known as septoplasty, when it is deemed medically necessary.


Breathing problems are common and can happen to anyone from time to time. However, if you regularly face difficulty breathing through your nose or have trouble sleeping because of blocked nasal passages, it may be a sign of a deviated nasal septum. In such cases, it is important to consult a doctor and seek proper treatment.


Read on to know more about this topic.


What is a Deviated Nasal Septum?


The septum is the thin wall of bone and cartilage between the two sides of the nose. A deviated septum occurs when the septum shifts to one side, obstructing airflow and making breathing difficult. This condition may be present from birth or develop following an injury or accident.


This can prevent air from moving through and make breathing difficult.


A deviated septum may also cause:



  • Breathing difficulties

  • Frequent nosebleeds

  • Snoring and sleep problems

  • Nasal blockage

  • Recurrent sinus infections

  • Pain in the face and headaches


What is Septoplasty?


Septoplasty is a surgery performed to fix a deviated septum. The procedure helps improve nasal breathing by straightening the septum inside the nose.


Septoplasty is often medically necessary because it improves nasal function and breathing. The surgery typically takes a few hours and is usually performed by an ENT specialist. It is sometimes performed as a daycare procedure, and most patients are able to go home the same day.


What Your Health Insurance May Cover?


If you have health insurance, it may cover it if:



  • The patient experiences significant breathing difficulty.

  • Medicines have not improved the condition.

  • The patient has chronic sinusitis or nasal blockage.

  • Treatment is supported by medical tests and the doctor's reports.


What is Covered Under Insurance?


Most health insurance and mediclaim policies cover several expenses related to septoplasty surgery. However, coverage can vary depending on the policy and insurer:


Hospitalisation Expenses


Typically, insurance will include coverage for the hospital stay and treatment, like, for example:



  • Room charges

  • Surgeon fees

  • Nursing charges

  • Operation theatre costs

  • Diagnostic tests

  • Medicines during hospitalisation


Daycare Procedure Coverage


Septoplasty can be performed on the same day and is a daycare surgery. Most contemporary health insurance plans will cover daycare without the need for lengthy hospital stays.


Pre-Hospitalisation Expenses


Some insurance companies will also cover costs prior to surgery, including:



  • Doctor consultations

  • Blood tests

  • Imaging scans

  • Medicines


Post-Hospitalisation Expenses


Patients may require follow-up consultations, medications, and post-surgical care after discharge. Many health insurance policies cover these expenses for a specified period following discharge.


Ambulance Charges


Some health insurance policies also cover the costs of an ambulance that may be used to take the patient to the hospital.


What is Not Covered Under Insurance?


Typically, cosmetic surgery is not covered by health insurance. The insurance claim may be denied if the surgery is performed solely for cosmetic reasons rather than for medical purposes.


For example, cosmetic rhinoplasty surgery performed solely for cosmetic reasons is typically not covered.