Rhinoplasty cost: reimbursement and insurance coverage

Nose surgery, also known as rhinoplasty, is one of the medical procedures belonging to the ENT field, which covers the ears, nose and throat. It can involve various types of operations driven by aesthetic as well as functional motivations. While in most cases rhinoplasty is not reimbursed by France’s national health insurance, certain situations may nonetheless qualify for coverage. In which cases is reimbursement possible? How much can it amount to? What steps do you need to take to benefit from it? Here is everything you need to know about the cost and insurance coverage of a rhinoplasty.

What does a rhinoplasty procedure involve?

Rhinoplasty is a plastic surgery procedure aimed at rebalancing the nose with the rest of the face, as well as correcting congenital defects, trauma or certain effects of ageing. It amounts to reshaping the nose by remodelling the bone and cartilage. It can also be used to relieve breathing difficulty, for example in the case of a twisted septum obstructing breathing or hypertrophy of the nasal turbinates. In that case it can pursue both aesthetic and functional goals.

When the procedure aims to correct a deviation of the septum, it is referred to as septoplasty or rhinoseptoplasty to correct the nasal septum: it is precisely these functional procedures that can qualify for coverage, unlike a purely morphological aesthetic rhinoplasty of the nose.

Which procedures can be covered by France’s national health insurance?

Not all nose surgery procedures are covered by the national health insurance. France’s health insurance fund actually covers only 2 specific types of rhinoplasty, which are considered to provide a permanent solution to a major, disabling everyday problem:

• so-called reconstructive or reparative rhinoplasty, which, as the name suggests, consists of repairing structural damage to the nose, such as a broken or deformed nose. The deformity may occur following an accident that caused a fracture (during an assault, for example). It may also be congenital in origin, with a birth defect. A cartilage graft may then be necessary to reconstruct the nose according to the patient’s wishes;
• functional rhinoplasty, which makes it possible to realign a deviated nasal septum that is obstructing normal breathing. The procedure can then take the form either of a septoplasty (which concerns only the nasal septum) or a rhinoseptoplasty (which addresses both the nasal septum and the external structure of the nose). In the case of mixed surgery, reimbursement is limited to the functional part of the procedure, while the aesthetic part remains the patient’s responsibility.

Purely aesthetic improvement of the nose, on the other hand, for example to make it more harmonious or to correct a minor defect, never qualifies for coverage by the health insurance.

For a septoplasty or a rhinoseptoplasty to be reimbursed, three conditions must in practice be met:

• a medical justification of the functional impairment, confirmed by an ENT examination (and, where applicable, a CT scan or a respiratory assessment);
• a procedure performed in an approved facility (an accredited clinic or hospital);
• a prior-authorisation request sent to the health insurance fund before the operation.

How much does a rhinoplasty cost?

The costs associated with aesthetic rhinoplasty can range from €6,000 to €10,000 depending on the type of surgery needed to correct the defects identified in the nose. The correction can indeed range from enlarging or shortening the nose to removing a bump on the bridge of the nose, which will involve very different procedure costs. While a septoplasty will most often cost between €2,000 and €4,000, a rhinoseptoplasty with insurance coverage will generally fall between €4,000 and €6,000.

To summarise the main orders of magnitude observed in France:

• aesthetic rhinoplasty: from €6,000 to €10,000 depending on the extent of the correction;
• septoplasty alone (functional procedure on the septum): from €2,000 to €4,000;
• rhinoseptoplasty (septum + external structure): from €4,000 to €6,000.

The price of a rhinoplasty is determined in particular by:

• the actual length of the operation, which determines the operating-theatre costs;
• the costs associated with hospitalisation;
• the technique used for the procedure;
• the fees of the specialist surgeon as well as of the anaesthetist;
• the number of pre-operative consultations required;
• the cost of the medication prescribed, whether before or after the procedure.

How much does insurance coverage amount to for a rhinoplasty?

The health insurance fund reimburses part of the costs related to hospitalisation for a rhinoplasty that qualifies for reimbursement. The national health insurance coverage base is 80% of the hospital costs and can reach 100% if it is a procedure following a workplace accident. Consultations before and after the procedure are also eligible for reimbursement by the health insurance fund. The same applies to certain treatments necessary for the procedure to be carried out properly.

Some costs will nonetheless remain entirely the responsibility of the insured. This is the case, for example, of:

• the daily hospital charge of €20 per day for a hospital room;
• a flat-rate contribution of €1 per consultation;
• any potential excess fees charged by practitioners;
• any additional comfort items in the hospital room (telephone, television, etc.).

The reimbursement ceilings of the national health insurance vary according to the type of procedure. Reimbursement is calculated on the basis of 80% of the agreed tariff. Here are the agreed-tariff amounts per operation, and the share actually reimbursed by the health insurance fund:

• septoplasty: agreed tariff of €175.56, i.e. about €140 reimbursed;
• narinal plasty for collapse of the internal nasal valve: €181.72, i.e. about €145 reimbursed;
• removal of a lesion or malformation of the nasal cavity: €197.89, i.e. about €158 reimbursed;
• rhinoseptoplasty: from €225.46 to €365.14, i.e. about €180 to €292 reimbursed;
• reimplantation of a nose fragment: €475.03, i.e. about €380 reimbursed;
• reconstruction of the nose with a framework: €684.89, i.e. about €548 reimbursed.

These amounts show that the national health insurance reimbursement, calculated on modest agreed tariffs, covers only a small fraction of the actual cost of the procedure: the bulk of the financing therefore rests on private health insurance and on the patient’s out-of-pocket share.

Coverage by private health insurance

Despite reimbursement by the health insurance fund, the out-of-pocket cost of rhinoplasty can often remain substantial, particularly because of excess fees. Turning to private health insurance then proves particularly worthwhile in order to limit the cost of the procedure. It must, however, be chosen carefully. Plastic surgery is in fact not reimbursed by hospitalisation-only private health insurance plans.

It is nonetheless possible to obtain partial reimbursement from private health insurers for rhinoplasties recognised by the health insurance fund as reconstructive and functional procedures. It is then preferable to choose a plan offering the highest level of coverage, particularly for hospitalisation costs, for coverage of the daily hospital charge, as well as for the option of an unlimited private room and a telephone/internet/television package.
Be sure to check beforehand the waiting period and any reimbursement ceilings.

Private-insurance reimbursement rates generally range from 100% to 600% relative to the base tariffs set by the national health insurance. So be sure to check your private health insurance contract to find out the exact terms of reimbursement. In concrete terms, for a septoplasty reimbursed on the basis of €175.56, a plan covering 200% of the agreed tariff will cover about €350: on a procedure billed at €1,500, the out-of-pocket cost will therefore still come to around a thousand euros, which is why it is worth aiming for a high level of cover.

For some plans, it is possible to benefit from particularly varied coverage that may include excess medical fees, hospitalisation days, additional options included, or even the medication and healing ointments for the recovery period.

Good to know: private health insurers only subsidise rhinoplasties in cases where these have already been covered by the national health insurance.

When the procedure remains your responsibility because it is purely aesthetic, many practices offer staggered payment allowing the cost to be spread over several monthly instalments. Don’t hesitate to raise this point at the first consultation: a detailed and transparent quote is systematically provided before any decision.

What about a failed rhinoplasty?

Patients who have undergone a failed nose surgery procedure may also benefit from reimbursement for so-called secondary rhinoplasties. These corrective procedures are covered by private health insurance and the national health insurance in certain specific cases:

• when the patient has a perforated nasal septum, i.e. with a communication between the two nostrils;
• in the event of progressive deformity of the nose due to healing defects;
• when the nostrils are too closed up and thus prevent the patient from breathing.

If the patient wishes to correct one of these functional problems caused by a previous failed rhinoplasty, reimbursement is then possible under the conditions previously mentioned.

For a second rhinoplasty motivated by smaller aesthetic errors such as imperfections in shape or asymmetry, the cost of the procedure this time falls to the patient, unless they have been able to have the surgeon held liable for the anomaly by a competent court. An amicable settlement can also be reached to consider a corrective procedure.

What procedure must be followed to obtain insurance coverage?

To obtain reimbursement for a rhinoplasty procedure, you need to follow a rigorous care pathway.

1. It must begin with an initial consultation with a specialist surgeon, with a referral provided by your general practitioner;
2. The specialist must then complete a form known as a « prior-authorisation request » attesting to the necessity of the procedure given your state of health.
3. This declaration is to be sent to the medical adviser of the health insurance fund, who must assess the pressing need for this type of surgery. The national health insurance is particularly attentive to arrangements between specialists and patients aimed at obtaining undue reimbursement. It has a maximum of 15 days to render its decision, with the absence of a response amounting to tacit acceptance and therefore effective reimbursement.
4. Once the decision has been rendered, you can then set a date with the specialist surgeon for the procedure. Hospitalisation is generally short (most often 24 to 48 hours). Some patients may even be operated on as outpatients and go home the same evening.

Please note, full coverage is only possible if the rhinoplasty procedure takes place in an approved plastic surgery clinic or hospital.

Beyond the financial question, it is worth recalling that correcting a breathing difficulty brings a lasting functional benefit: a study published in JAMA Network Open (Nassiri et al., 2020) showed that the NOSE score, which measures the nasal obstruction perceived by the patient, fell from a median of 70 before the procedure to 15 after a septoplasty, an improvement that was maintained over time. When a breathing difficulty is genuinely present, septum surgery therefore addresses a real quality-of-life issue, and not merely a question of reimbursement. For corrections without a functional aim, a non-surgical rhinoplasty performed without surgery through injections can also offer a lighter alternative, but it then does not qualify for any coverage.