Wording the pre-auth differently

[Guest guest]

My OS sent in a pre-auth for surgery for " malocclusion. " Well my

insurance plan will not cover " treatment for malocclusion " and I

found out that my plan is self-funded. I tried the statute saying

that the insurance people cannot deny any treatment of the jaw, neck

etc., but the way they got around that was ERISA. So I cannot have

this surgery for " malocclusion. " Plus my OS was no help in trying

to get it covered for me. So I was thinking that if I change my OS

and he words the pre-auth differently to say nothing

of " malocclusion " that the surgery will be covered. My plan does

cover treatment for TMJ, which I have and it covers reconstructive

surgery, i.e., oral surgery due to deformity, basically what I have

too. I have 16mm overbite, TMJ, neck pain, shoulder pain, the whole

ten yards. And it's getting worse as I get older. I want this

surgery done so bad and hoping that trying this way will help me get

it covered. Has anybody's OS tried to word the pre-auth a little

differently (but meaning the same thing) in order to get the surgery

done? If so, did it get covered? Any advice would be helpful.

Thanks.

[Guest guest]

Your case sounds alot like mine. I went through 3 insurance

providers over the course of 3 years trying to approve this surgery.

The thing is, the only symptom of TMJ I have is headaches. The first

two insurance providers would not approve on those grounds only, and

malocclusion didn't sell either. You seem to have a more pronounced

case of TMJ, so I think you shouldn't have any trouble getting it

approved if you have your OS puts that in his pre-auth. Another

thing my OS did was to have lunch with my orhto to brainstorm the

best way to get it approved.

Luke

> My OS sent in a pre-auth for surgery for " malocclusion. " Well my

> insurance plan will not cover " treatment for malocclusion " and I

> found out that my plan is self-funded. I tried the statute saying

> that the insurance people cannot deny any treatment of the jaw,

neck

> etc., but the way they got around that was ERISA. So I cannot have

> this surgery for " malocclusion. " Plus my OS was no help in trying

> to get it covered for me. So I was thinking that if I change my OS

> and he words the pre-auth differently to say nothing

> of " malocclusion " that the surgery will be covered. My plan does

> cover treatment for TMJ, which I have and it covers reconstructive

> surgery, i.e., oral surgery due to deformity, basically what I have

> too. I have 16mm overbite, TMJ, neck pain, shoulder pain, the

whole

> ten yards. And it's getting worse as I get older. I want this

> surgery done so bad and hoping that trying this way will help me

get

> it covered. Has anybody's OS tried to word the pre-auth a little

> differently (but meaning the same thing) in order to get the

surgery

> done? If so, did it get covered? Any advice would be helpful.

> Thanks.

>

>