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Naturally the first step is to have insurance. Ideally you will have a generous insurance plan that allows you to see any doctor for any problem. If you do not, prior to attempting to get a rhinoplasty paid for by your insurance I suggest you upgrade your plan if possible. The reason being that with plans that do not allow you to see just anyone and require their "doctors" to examine you the chances of getting a nose job on the insurance drop dramatically and any subsequent plan you have will claim that your nose issues are pre-existing and therefore precluded from coverage, even with the best of plans. So before attempting this make sure you have your health insurance in order so you can get this done on your first try.
The next and most important step is choosing a surgeon. It is not well known but many ENT (ear, nose and throat) doctors actually are skilled at performing rhinoplasties, or nose jobs, as well. It is important that you check prior to consultation to ensure that your doctor is capable of doing both ENT work and plastic surgery. If you cannot find an ENT with these qualifications you may want to check with a plastic surgeon but one whose office title is not blatantly screaming "plastic surgery".
Ideally the doctor will be a member of the American Board of Plastic Surgeons in addition to displaying the FACS (Fellow of the American College of Surgeons). A cosmetic surgeon and plastic surgeon are NOT the same thing though few people know this. The dual certification will let you know you are in good
hands and further to that you will want to ask for samples of the surgeons work.
Next you will want to make sure your doctor is a fairly liberal doctor. You can go for several consultations if you have a good insurance plan and it may even be worth paying out of pocket if you have a limited plan to ascertain whether the surgeon can do what you want and will accommodate your insurance needs.
When you go for the exam what you will want to do is to present with a breathing issue. Though almost all doctors will see through this doctors usually do not turn away money, especially in private practice. If they know from the start that your goal is to get a nose job it is all the better. If you do go to a plastic surgeon with a cryptic office name (your best bet) they will almost invariably work with you to get your insurance to pay the fees. In either case your goal is to present as a breathing issue or deviated septum and under the guise of this diagnosis get the surgeon to actually perform a nose job on you. This is a lot more common and much easier than one would think and most surgeons are more than willing to oblige and will often diagnose a perfectly healthy nose as a deviated septum precisely for this reason. The key though is to say as little as possible blatantly as once a doctor hears or says this they can be liable for insurance fraud. Until they state this or it is stated to them, at worse they are guilty of a bad diagnosis.