Is Balloon Sinuplasty Covered By Insurance? Everything You Need to Know


After undergoing sinus surgery, many patients are left with residual problems, including chronic nasal congestion or pain that prevents them from living life to the fullest.

Fortunately, balloon sinuplasty can relieve these problems by creating more space in the sinuses and opening the passageways clogged with mucus.

But how much does balloon sinuplasty cost? How do you know if your insurance will cover it? And what if your insurance doesn’t cover it? Let’s find out everything you need to know about balloon sinuplasty coverage!

What is sinusitis?

Sinusitis is a chronic inflammation of one or more of your sinuses. Most often, sinusitis is caused by an infection or allergies, but there are other causes too.

If you’re suffering from long-term symptoms that aren’t going away, you should see a doctor as soon as possible. The first step in getting treatment for your condition is figuring out what type of sinusitis you have.

Doctors use medical terms to describe three different types: Acute (also known as acute rhinosinusitis): Lasting less than four weeks, acute rhinosinusitis can be caused by an upper respiratory tract infection like a cold or flu. Chronic (also known as chronic rhinosinusitis): Symptoms last longer than 12 weeks. It may start with acute symptoms that never go away or occur after an illness like strep throat. Recurrent (also known as recurrent rhinosinusitis): Repeated episodes of either acute or chronic rhinosinusitis over time.

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How balloon sinuplasty can help with nasal issues

Although traditional surgeries for sinus issues are being used less frequently in favor of less invasive procedures, balloon sinuplasty is a few minimally invasive surgery that is quickly becoming more popular.

Balloon sinuplasty is an endoscopic procedure that opens up airways in your nose and reduces blockages. Your nose has several functions, including keeping your brain healthy by supplying it with fresh oxygen-rich air; it also helps maintain normal body temperature by releasing excess heat through your nostrils.

It’s important to take care of your nose because it can affect so many other parts of your body. When you have nasal issues, such as nasal congestion or chronic sinusitis, there are several different ways you can treat them.

In some cases, doctors will recommend medications like antihistamines or antibiotics; if these don’t work or cause too many side effects, you might be referred to a specialist who can perform balloon sinuplasty on you.

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Who should use this treatment

Sinus issues affect millions of people each year. For some, standard treatments like antibiotics and decongestants can help, but surgery is an option for many others.

If you have sinus pain that’s causing problems in your daily life, one option is balloon sinuplasty. This minimally invasive procedure reshapes your nasal passages by using a small balloon catheter to widen them.

This treatment aims to remove blockages and improve drainage within your nose and sinuses so that inflammation can go down, symptoms ease up, and you can feel better overall.

Where can you get this procedure done

A provider can place balloon sinuplasty inside your nose to unblock obstructed sinuses. The procedure is done in an office, and patients usually experience less pain and feel better faster than they would with traditional open surgery.

Once you’ve been approved for Medicare, Medicaid or private insurance coverage, it may be possible to get a balloon sinuplasty covered. However, this is dependent on your specific plan and where you live.

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Pricing and payment information

According to Inova Health System, a sinus surgery at a hospital can cost anywhere from $4,000 for standard outpatient procedures such as polypectomy to as much as $35,000 for open surgeries.

On average, though, a sinus procedure will cost patients around $10,000. These are, of course, averages, and costs can vary greatly depending on your health plan and whether you choose in-network or out-of-network treatment.

INSURANCE COVERAGE FOR BALLOON SINUPLASTY

You’re probably wondering, is balloon sinuplasty covered by insurance? Currently, balloon sinuplasty is not covered by most insurance companies.

Alternative financial arrangements can be made if payment plans are necessary. Your doctor will be able to give you more information about how much coverage and what type of financing will be available for your balloon sinuplasty.

Is it safe

The cost of balloon sinuplasty is considerably higher than that of a traditional sinus surgery—with good reason. According to Dr. Steven Cohen, Chairman of New York University’s Department of Otolaryngology and Director of NYU Langone Hospital’s Tisch Hospital Center for Advanced Dentistry and General Practice, Balloon sinuplasty requires more skill, training and experience.

It’s also more expensive because of all those balloons. Many insurance companies consider balloon sinuplasty as an outpatient procedure, meaning there will be little or no out-of-pocket expense on your part. Your insurance company may require pre-authorization before covering any portion of your ballooning treatment costs.

FAQs on Is Balloon Sinuplasty Covered By Insurance?

Does medicare cover balloon sinuplasty?

Medicare only covers balloon sinuplasty if performed as part of a research study. This means that medicare won’t cover sinus surgery unless you participate in a clinical trial or a study approved by an institutional review board (IRB).
An IRB is responsible for ensuring that all research involving human subjects is safe and ethical. The process is rigorous and time-consuming, but if you have chronic sinusitis with comorbidities—such as asthma, diabetes, heart disease, etc.—and are interested in enrolling in a study, talk to your doctor about participating.

Is balloon sinuplasty permanent?

One of the common questions about balloon sinuplasty is whether or not it is permanent. The truth is that it’s a bit more complicated than that, but in general, you can expect your sinuses to stay open long-term if you keep up with your maintenance.

Balloon sinuplasty cost with insurance?

You can rest assured that it will cover at least part of your sinus surgery if you have insurance. The most important thing to know is how much coverage you are entitled to and how much out-of-pocket cost there will be.
If your deductible is higher than $500, there may be little help in terms of cost from your insurance company. But if there is no deductible or only a small one, contact your insurance provider with any additional questions about coverage before moving forward with sinus surgery. You don’t want any surprises along the way! Most plans will ask for pre-authorization before they agree to pay for balloon sinuplasty—but not all plans do so; some leave it up to individual providers within their network.


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