Insurance

[Guest guest]

Has anyone (in the US) successfully had insurance pick the tab on the

surgery? What was the wait time and authorization process like?

Jo

[Guest guest]

I have Blue Cross and Blue Shield. It took 2 separate appeals and a

bunch of extra x-rays over the course of about a year and three

months before it was approved. The surgeon originally told me that

yes, chances are they will cover it but it would take some time, and

it did. His office took care of most of the paperwork and referred

me to the appropriate office at the appropriate time for

appointments. Going to them was the only part I had in the process.

I'll give you a hint, going to a teaching hospital and finding an OS

from amongst the staff is a good way to go. Fees are cheaper and my

surgeon even offered to waive them if, after all the orthodontic

work, the surgery wasn't approved (I made it quite clear I wouldn't

start anything without a guarantee). The only catch was that I had

to be his class' guinea pig. To me, that was acceptable because I

know that they are completely qualified by the time they saw me to

perform the surgery (if they werent only simply assisting). Plus,

once upon a time I wanted to be a doctor and realize that if no one

ever let me work on them then I would never learn.

Also, some offices offer payment plans if the procedure is not

covered by your insurance. There are even some companies that

specialize in loans to cover surgical costs.

> Has anyone (in the US) successfully had insurance pick the tab on

the

> surgery? What was the wait time and authorization process like?

>

> Jo

[Guest guest]

My surgery was covered under medical, not dental, insurance. I was

one of the lucky ones in that I did not have to do any appealing.

My surgery was approved on my first go. My surgeon's office did

pretty much all the work for it. I got a copy of the letter he sent

to the insurance company. In it, he stated something to the effect

of the surgery being necessary to " correct a skeletal

malformation. " Seeing it put that way wasn't pleasant, but it

worked, and that's all that mattered. I've read about other people

having success when their doctors put it that way as well.

Some insurance companies spell out a specific exclusion of

orthognathic surgery in the plan policies. While this makes matters

more challenging, it does not mean coverage is not possible. Some

have had success when they've dug into the laws of their state.

Others have found that their insurance says it covers surgeries to

correct congenital conditions while still excluding orthognathic

surgery, which amounts to very contradictory policy and a footing

for patients and doctors to appeal.

Good luck. Insurance is frustrating, but hang in there and don't be

afraid to fight if you're forced to.

> Has anyone (in the US) successfully had insurance pick the tab on

the

> surgery? What was the wait time and authorization process like?

>

> Jo

[Guest guest]

I had united healthcare and it took a year to get a denial and three

months for the appeal to be approved. They required more information

and there was an exclusion to any type of treatment for malocclusion

(overbite), and so I thought it was over for me. We then proceeded

to do a sleep study when the OS noticed a very narrow air

passageway. Studies proved that I did have obstructive sleep apnea.

My recessed jaw was causing this and the surgery would correct it.

That was when I finally got approved. Just keep appealing and don't

let them tell you otherwise!

> Has anyone (in the US) successfully had insurance pick the tab on

the

> surgery? What was the wait time and authorization process like?

>

> Jo

[Guest guest]

Yes.

I was preapproved on first submission. When that expired, my surgeon

resubmitted, on a schedule for surgery, and the approval was renewed.

It was easy for me, but I have very good coverage and a surgeon

learned in all things insurance. And this whole experience was most

fortunate for me in all regards. May yours be likewise.

Cammie

> Has anyone (in the US) successfully had insurance pick the tab on

the

> surgery? What was the wait time and authorization process like?

>

> Jo