Guest guest Posted May 13, 2004 Report Share Posted May 13, 2004 Hi everyone, My daughter is 16 yrs old. She had braces for about 2 years, teeth were fine. Then her lower jaw decided to grow! Now she needs orthognathic surgery and braces again. I just got her blue cross blue select ins. and they told the os it didn't cover the surgery. I'm self employed and don't have another option for ins. Which insurance covers this surgery? Maybe I can get a job that has this plan. Thanks for the help! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2004 Report Share Posted May 14, 2004 Is your insurance a self funded plan? If not, there is a state statute that says that insurance co's cannot deny surgery on the jaw, face and neck and they have to cover it. But some states do not have this statute. If your plan is self funded, then it is covered under ERISA and they can deny it. What state are you in and I maybe I can help in finding the statute for you. Also, find out if your insurance is self funded. Do you have the booklet that says what they cover and the exclusions? You need to take a look at that and see what it says for this type of surgery. > Hi everyone, My daughter is 16 yrs old. She had braces for about 2 > years, teeth were fine. Then her lower jaw decided to grow! Now she > needs orthognathic surgery and braces again. I just got her blue > cross blue select ins. and they told the os it didn't cover the > surgery. I'm self employed and don't have another option for ins. > Which insurance covers this surgery? Maybe I can get a job that has > this plan. Thanks for the help! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2004 Report Share Posted May 14, 2004 Hi, I also have BCBS of NY and they also state in their booklet that they do not cover this surgery, however, when your surgeon sends in all the xrays etc and writes what it is for they will cover it as long as its not cosmetic. My daughter is having her surgery this July and they are covering 80% bec he is not in the group. They are not covering her chin bec no matter what he writes they still insist that it is cosmetic. Good Luck, Re: Help! Insurance questions Is your insurance a self funded plan? If not, there is a state statute that says that insurance co's cannot deny surgery on the jaw, face and neck and they have to cover it. But some states do not have this statute. If your plan is self funded, then it is covered under ERISA and they can deny it. What state are you in and I maybe I can help in finding the statute for you. Also, find out if your insurance is self funded. Do you have the booklet that says what they cover and the exclusions? You need to take a look at that and see what it says for this type of surgery. > Hi everyone, My daughter is 16 yrs old. She had braces for about 2 > years, teeth were fine. Then her lower jaw decided to grow! Now she > needs orthognathic surgery and braces again. I just got her blue > cross blue select ins. and they told the os it didn't cover the > surgery. I'm self employed and don't have another option for ins. > Which insurance covers this surgery? Maybe I can get a job that has > this plan. Thanks for the help! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2004 Report Share Posted May 14, 2004 I have Blue Cross Blue Shield of Florida, HMO, and they covered the entire surgery. I paid for the braces (almost $5000) and a co-pay for the specialist (the OS) of $35, a co-pay to the hospital of $100 plus $35 extra to have a private room. It might depend on which state you are in, but I would ask around about BCBS, if you talked to someone on the phone, they might not know what you talking about and assume that it is something cosmetic. One way to be sure that your OS accepts your insurance is to ask them which insurance their patients use the most. I didn't have any choice on who I went to. There are only two OS in my area who do this operation, and one didn't accept my insurance. Good Luck ~Cathy Help! Insurance questions Hi everyone, My daughter is 16 yrs old. She had braces for about 2 years, teeth were fine. Then her lower jaw decided to grow! Now she needs orthognathic surgery and braces again. I just got her blue cross blue select ins. and they told the os it didn't cover the surgery. I'm self employed and don't have another option for ins. Which insurance covers this surgery? Maybe I can get a job that has this plan. Thanks for the help! ------------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.