The Full Cost of Pre-Rhinoplasty Tests and Which of Them Insurance Pays For

What do the tests before rhinoplasty cost, and which of them does insurance pay for?

The short answer: tests before rhinoplasty are usually done at a laboratory and paid for separately from the surgical figure; what they cost depends on the number of tests, the laboratory and where the sample is taken, and we deliberately write no number for it, because every laboratory has its own tariff and figures change. On insurance, the general rule is that for a purely cosmetic rhinoplasty the tests are normally the patient's own cost; only when the operation has a documented therapeutic purpose (for example septoplasty for a breathing problem) may the tests also fall within your insurance contract. You have to ask your own insurer.

So instead of a number, this article gives the method of estimating: what goes into the basket of tests, what pushes the price up, what to ask the laboratory, and what to clarify before you file anything with the insurer. We give the list and timing of the tests themselves in our guide to pre-rhinoplasty tests and here deal only with the cost side. This article is educational and does not replace your surgeon's opinion, your file or the text of your insurance contract.

What tests are in the basket?

For a healthy person with no underlying condition or regular medication, the basic list is short: a complete blood count (CBC), clotting tests (PT, PTT and INR), fasting blood glucose and, for women, a pregnancy test; a urine test and kidney and liver function are also requested depending on circumstances. The remaining tests (such as an ECG) are added on the basis of age, underlying condition and the type of anesthesia. Each is explained in the guide to the tests.

This means your cost is made of two things: the number of basic tests, and what the surgeon or anesthesiologist adds for your situation. NICE's guidance on routine pre-operative tests for elective surgery stresses that requests should be based on the patient's physical condition and the grade of surgery, not on one fixed list for everyone. So if you were given a short list, it is not necessarily carelessness; and if you were asked for a long one, you are entitled to ask the reason.

What raises the cost of tests?

• The number of extra tests: age, an underlying condition or a regular medication may add an ECG or supplementary tests.
• The laboratory: each laboratory has its own tariff; two may charge different figures for the same test.
• Where the sample is taken: home sampling may carry a separate charge; ask. (We describe the choice between laboratory and home in the guide to the tests.)
• Repeating because of expiry: results have a validity period; if you test too early or the surgery is delayed you may have to test, and pay, again.
• Repeating because of a medical event: a heavy cold, a fever or a new medicine between the tests and the surgery can put the validity of the results in doubt.
• An abnormal result: a borderline or abnormal result (for example low hemoglobin) may call for further tests or a visit.

How do you estimate the cost in advance?

Suggested steps:

• Get the request form from the clinic: ask exactly which tests are required and how long before surgery each must be done.
• Ask the laboratory for the price of each test: not a total for a "package", but the price of each one.
• If you compare two laboratories, price the same list of tests at both; comparing two different baskets is not fair.
• Allow for the cost of repeating: if the surgery date is not fixed, do not test earlier than the recommended time; ask the clinic for the window.
• If you live in another city, ask whether results from your own city's laboratory are accepted; as we explain in the article on the real cost for an out-of-town patient, this can save one night of lodging, provided it is agreed beforehand.
• Put this line in your total estimate: tests and medication are not part of the starting figure; see which lines are usually separate in the article on the hidden costs of rhinoplasty, and Se Rokh's figures in the article on rhinoplasty cost in Tehran.

When does insurance pay for the tests?

Insurance looks at the medical reason for the operation, not its title; we explain this principle in the article on insurance and nose surgery. On that basis three situations can be imagined; the exact rule for each is in your contract, and these are only a guide to what to ask:

Four questions for the call to the insurer:

• Are pre-surgical tests with this diagnosis covered by my contract?
• What documents are needed for payment or reimbursement? (The surgeon's request form stating the diagnosis, the original laboratory invoice, the results)
• Must the laboratory be contracted, or can I be reimbursed for any laboratory?
• What is the filing deadline, and what are the coverage percentage and ceiling?

Two practical points: the test request form must show the real medical reason for the operation correctly; do not ask the clinic to change anything to obtain cover. And keep the original invoice and the results, because both the insurer and the surgeon may need them. We describe the structure of the supplementary insurance share in the article on septoplasty cost and the insurance share.

Four costly mistakes

• Testing too early: at the first consultation and months before the surgery date is set; the chance of expiry and repetition rises.
• Testing without a request form: a test the surgeon did not ask for may not be needed and creates a pointless cost, or the one that is needed may be missed.
• Losing the originals: keeping the original sheets prevents hurried calls and repeats on the morning of surgery.
• Not mentioning medicines and supplements: some medicines and supplements affect clotting and the results and may change the tests or the decision; the list is in the article on medicines and supplements before surgery.

If a result is abnormal, what happens to the cost?

A borderline or abnormal result does not mean "you will never have surgery"; most of the time it means a further test or consultation and sometimes a later date. These lines are usually not in the first estimate and you should keep a small margin for them in the budget: a repeated or supplementary test, a visit to an internist or a cardiologist and, if the date moves, the cost of lodging or tickets for a visiting patient. In elective surgery a postponement is a safety tool, not a failure; and the decision about an unusual result belongs to the surgeon and the anesthesiologist, not to you.

When to consult a doctor

A consultation is needed when you have an underlying condition (heart, diabetes, anemia, thyroid), take a regular medication or have a history of unusual bleeding; the list of tests, and so their cost, is set by your circumstances. If you receive an abnormal result, speak to your surgeon or treating physician. The articles on thyroid disease and anesthesia and on anemia and rhinoplasty are examples of this situation.

To book, use the booking form or the contact page and ask how to obtain the test request form before you go to the laboratory. See the surgeons in the doctors section and read about the rhinoplasty page and the septoplasty page.

Sources

• NICE — Routine preoperative tests for elective surgery (NG45)
• American Society of Plastic Surgeons — Rhinoplasty Cost (components of the surgical cost)
• MedlinePlus — Complete Blood Count (CBC)
• MedlinePlus — Prothrombin Time Test and INR (PT/INR)
• Mayo Clinic — Rhinoplasty