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Does Cigna Cover Sinus Surgery?

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Sinus surgery as covered by Cigna depends on the medical necessity of a patient’s individual condition. Complications due to sinuses or injury, chronic sinus problems in relation to overall health or a continuous battle with sinus problems can all constitute for the need of a surgical procedure.

Like most patients, I bet you’re wondering if your insurance company will cover any sinus procedure that you have. This is complicated to answer, as the specifics of each case are different, and coverage is based on an assessment done by your doctor and insurance companies coverage policy.

The following is a detailed description as to what Cigna covers in terms of a rhinoplasty procedure:

  • If there is a nasal deformity that is secondary to a cleft lip or any other deformity that causes impairment in everyday functionality
  • If the nasal passage is obstructed in anyway because of an internal collapse of valves that comes secondary to disease or trauma. This must be depicted with evidence that is photographically documented to show the condition and an airway obstruction to the nasal that has proven to be unresponsive to non-invasive treatment (of at least 6 weeks).

The following is a detailed description as to what Cigna covers in terms of a septoplasty procedure:

  • If the septal deviation is causing an obstruction to the nasal airway and it is not responding to previous treatment (of at least 6 weeks)
  • If there is proof of epistaxis related to a nasal deformity that is reoccurring.
  • Any deformity that prevents access to areas of the nasal cavity and in-turn causes other issues
  • If the procedure is done in accordance to another deformity such as a cleft lip or cleft palate
  • Breathing that is effected by a deformity that has not shown any improvement or response to formal medical management or treatment.

Cosmetic:

Rhinoplasty and septoplasty are considered cosmetic procedures when they are meant only for the purpose of enhancing appearance. Cigna will determine whether or not there is a medical need for either procedure or address that it is cosmetic based on their terms, in which case the procedure will not be covered.

The specifics of what is and is not covered by Cigna for sinus surgery is detailed and specific. If you have questions that pertain to your individual case that were not mentioned here, please call us at (855) 690-0565 to learn more about Cigna insurance and sinus treatments.

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