Guest guest Posted July 28, 2004 Report Share Posted July 28, 2004 I'm thinking about switching health insurance for next year if it turns out that United Healthcare doesn't approve surgery. Anyone have Kaiser and got their surgery approved recently? Did you have to appeal to get it? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2004 Report Share Posted July 28, 2004 I have had Kaiser for years and have never had a problem. I called my regular med doc and told her what I was considering and played up the TMJ (mild, usually aggravated by dental work) and she refered me to the OS without seeing me (I have a very good relationship with her). I then saw my OS and basically if they were not going to approve it, I was not going to get braces and do the whole process. She took one look at my palate and said that that was one of the narrowest pallates she had ever seen. I had a severe cross bite. She approved it right there and I even made her say it again because that was the deciding factor. Her assistant told me that the surgey was a $30,000 surgery. So I went ahead. I had braces for a year and a half. Surgery was postponed for a year after my 1st date. Had the surgery on June 17th and am doing fine. I would absolutely recommend Kaiser. > I'm thinking about switching health insurance for next year if it > turns out that United Healthcare doesn't approve surgery. Anyone > have Kaiser and got their surgery approved recently? Did you have to > appeal to get it? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2004 Report Share Posted July 28, 2004 I had my surgery approved by both Cigna and Kaiser on the first try. I guess with a 12mm overbite, sleep apnea, snoring, and morning headaches, they both found it medically necessary pretty easily. The reason I had both approved was because my employer dropped Cigna at the beginning of this year. Even so, Kaiser was by far easier, even though neither were difficult. For Kaiser I saw my new primary care doc. She referred my out of network to my OS, who does all the Kaiser maxillofacial work in our area. He took one look, and approved it on the spot and got to work taking x-rays and models. Easy as pie. Dammit > I'm thinking about switching health insurance for next year if it > turns out that United Healthcare doesn't approve surgery. Anyone > have Kaiser and got their surgery approved recently? Did you have to > appeal to get it? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2004 Report Share Posted July 28, 2004 I've had Kaiser for about 2 years now. When I first decided to get braces and found out that I would need SARPE, I spoke to my general about getting kaiser to cover it, but with no success. On two seperate occasions I asked my doctor and both times he said that they do not do that sort of thing. One time I had to go in for an emergency visit for a busted toe and my regular doctor was not in. The doc that did see me was much more open to referring me for a consult with the MFS department and gave me a referral. So two weeks before I met with the head of the MFS dep at SF med school, which would have cost 200 for the consult and 30k+ for the procedure, I got a meeting with the Kaiser staff. Though the Kaiser MFS dep all the way in Oakland, I am glad I went. With in the first 2 minutes of the consultation I was approved for all three procedures, though I only need the SARPE. I was amazed how fast I was approved and how much they were willing to cover the complete procedure. I dont think I will be going through with anything but the SARPE, but I am very happy not to have to pay any thing for it. I hope it helps. Arde > I'm thinking about switching health insurance for next year if it > turns out that United Healthcare doesn't approve surgery. Anyone > have Kaiser and got their surgery approved recently? Did you have to > appeal to get it? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2004 Report Share Posted July 28, 2004 What exactly is a SARPE? Thanks > > I'm thinking about switching health insurance for next year if it > > turns out that United Healthcare doesn't approve surgery. Anyone > > have Kaiser and got their surgery approved recently? Did you have > to > > appeal to get it? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2004 Report Share Posted July 28, 2004 Surgically Assisted Rapid Palatal Expansion > What exactly is a SARPE? > > Thanks Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2004 Report Share Posted July 28, 2004 When the orthodontist first told me I needed the surgery and that it would cost $30,000, I freaked out. I did some research and found out on this very website that people were getting it done at Kaiser and it was covered. I had to go through a few hoops: met with my primary who seemed puzzled by my request (she had never heard of the procedure and didn't think Kaiser did it), but she relented and sent me to head and neck surgery for a consult. The doctor walked in, looked at me, and said, " Oh yeah, you need surgery. " He then referred me to the oral and maxillofacial dept. My meeting with them was much the same. I was immediately approved for lower jaw surgery and will have it on December 3. And as an aside, there really seem to be a lot of folks here who are getting it done at Kaiser, especially in Oakland. Maybe I should start a website!?! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2004 Report Share Posted July 28, 2004 Alot of Oakland people. Dr. O' is great as is her entire staff. Never did meet the other OS there but they work as a team.-- In orthognathicsurgerysupport , mstiness wrote: > When the orthodontist first told me I needed the surgery and that it > would cost $30,000, I freaked out. I did some research and found out > on this very website that people were getting it done at Kaiser and > it was covered. > > I had to go through a few hoops: met with my primary who seemed > puzzled by my request (she had never heard of the procedure and > didn't think Kaiser did it), but she relented and sent me to head and > neck surgery for a consult. The doctor walked in, looked at me, and > said, " Oh yeah, you need surgery. " He then referred me to the oral > and maxillofacial dept. My meeting with them was much the same. I was > immediately approved for lower jaw surgery and will have it on > December 3. > > And as an aside, there really seem to be a lot of folks here who are > getting it done at Kaiser, especially in Oakland. Maybe I should > start a website!?! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2004 Report Share Posted July 28, 2004 I had my surgery done by Dr. O'Rion. I love her, she's so kind and sweet as well as an excellent surgeon with years of experience. She works with Dr. Poor as a team. She's left handed and he's right handed. They make a great duo. > > When the orthodontist first told me I needed the surgery and that > it > > would cost $30,000, I freaked out. I did some research and found > out > > on this very website that people were getting it done at Kaiser > and > > it was covered. > > > > I had to go through a few hoops: met with my primary who seemed > > puzzled by my request (she had never heard of the procedure and > > didn't think Kaiser did it), but she relented and sent me to head > and > > neck surgery for a consult. The doctor walked in, looked at me, > and > > said, " Oh yeah, you need surgery. " He then referred me to the oral > > and maxillofacial dept. My meeting with them was much the same. I > was > > immediately approved for lower jaw surgery and will have it on > > December 3. > > > > And as an aside, there really seem to be a lot of folks here who > are > > getting it done at Kaiser, especially in Oakland. Maybe I should > > start a website!?! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2004 Report Share Posted July 29, 2004 I have my first meeting with Dr. Poor on the 19th, 8 days before the big day. My Ortho has worked with both for many years, and highly recommended O'. I am glad to hear that poor and oryan work together. I am excited nervious and anxious about getting this over with. We should have orthognathicsurgerysupport, bay area branch party. hehehe Arde > > > When the orthodontist first told me I needed the surgery and > that > > it > > > would cost $30,000, I freaked out. I did some research and found > > out > > > on this very website that people were getting it done at Kaiser > > and > > > it was covered. > > > > > > I had to go through a few hoops: met with my primary who seemed > > > puzzled by my request (she had never heard of the procedure and > > > didn't think Kaiser did it), but she relented and sent me to > head > > and > > > neck surgery for a consult. The doctor walked in, looked at me, > > and > > > said, " Oh yeah, you need surgery. " He then referred me to the > oral > > > and maxillofacial dept. My meeting with them was much the same. > I > > was > > > immediately approved for lower jaw surgery and will have it on > > > December 3. > > > > > > And as an aside, there really seem to be a lot of folks here who > > are > > > getting it done at Kaiser, especially in Oakland. Maybe I should > > > start a website!?! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2004 Report Share Posted July 29, 2004 I have my first meeting with Dr. Poor on the 19th, 8 days before the big day. My Ortho has worked with both for many years, and highly recommended O'. I am glad to hear that poor and oryan work together. I am excited nervious and anxious about getting this over with. We should have orthognathicsurgerysupport, bay area branch party. hehehe Arde > > > When the orthodontist first told me I needed the surgery and > that > > it > > > would cost $30,000, I freaked out. I did some research and found > > out > > > on this very website that people were getting it done at Kaiser > > and > > > it was covered. > > > > > > I had to go through a few hoops: met with my primary who seemed > > > puzzled by my request (she had never heard of the procedure and > > > didn't think Kaiser did it), but she relented and sent me to > head > > and > > > neck surgery for a consult. The doctor walked in, looked at me, > > and > > > said, " Oh yeah, you need surgery. " He then referred me to the > oral > > > and maxillofacial dept. My meeting with them was much the same. > I > > was > > > immediately approved for lower jaw surgery and will have it on > > > December 3. > > > > > > And as an aside, there really seem to be a lot of folks here who > > are > > > getting it done at Kaiser, especially in Oakland. Maybe I should > > > start a website!?! 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.