blue cross blue shield of mass.

[Guest guest]

I have been told that I need orthognathic surgery for my

crossbite/openbite to be improved. I would need about a year of

braces and then the surgery. I was wondering if anyone out there

has insurance through Blue Cross Blue Shield and if they had any

problem getting insurance to cover this procedure. Any feedback in

connection to this would be very helpful. Thank you.

[Guest guest]

I have bcbs of ny and they approved upper/lower/chin for my daughter,

braces were covered under her dental plan

wendy

blue cross blue shield of mass.

I have been told that I need orthognathic surgery for my

crossbite/openbite to be improved. I would need about a year of

braces and then the surgery. I was wondering if anyone out there

has insurance through Blue Cross Blue Shield and if they had any

problem getting insurance to cover this procedure. Any feedback in

connection to this would be very helpful. Thank you.

[Guest guest]

I have bc/bs of De and my surgury was approved in 8 days.

>

I have been told that I need orthognathic surgery for my

> crossbite/openbite to be improved. I would need about a year of

> braces and then the surgery. I was wondering if anyone out there

> has insurance through Blue Cross Blue Shield and if they had any

> problem getting insurance to cover this procedure. Any feedback in

> connection to this would be very helpful. Thank you.

[Guest guest]

I have BCBS of PA and they covered everything without a problem.

Marsha

> I have been told that I need orthognathic surgery for my

> crossbite/openbite to be improved. I would need about a year of

> braces and then the surgery. I was wondering if anyone out there

> has insurance through Blue Cross Blue Shield and if they had any

> problem getting insurance to cover this procedure. Any feedback in

> connection to this would be very helpful. Thank you.

[Guest guest]

I have BCBS of MN, and after being denied initially, was finally

approved based on " medical necessity. " You're right: You (or your

O.S.) do, in fact, need to prove that you have a DYSfunctional

physical abnormality, as there are many physcial abnormalities that

are still very much functional. That is what it boils down to. In

my case, my O.S. was not very aggressive in helping me get the

surgery covered; I had to do the work myself. After the initial

denial, they sent me some questions asking about my symptoms, health

history, what caused the symptoms, and had I tried anything to

alleviate the symptoms (TMJ). What you need to stress to them is

how your jaw is not functioning on a daily basis (e.g., chewing,

talking, biting,etc.). I would strongly suggest you stress to them

the problems and pain you have that results in doing these regular

activities that require jaw movement. You need to show them that it

is causing you to function differently, and adversely with your

every day, common movements of the jaw, and that surgery is the only

thing that will alleviate the problems. I know it's discouraging,

but keep pushing; you will eventually get it covered! Best of luck

to you....

> > I have been told that I need orthognathic surgery for my

> > crossbite/openbite to be improved. I would need about a year of

> > braces and then the surgery. I was wondering if anyone out

there

> > has insurance through Blue Cross Blue Shield and if they had any

> > problem getting insurance to cover this procedure. Any feedback

in

> > connection to this would be very helpful. Thank you.

[Guest guest]

I might mention, too, that my surgeon specifically wrote about the

headaches I had reported to him, as well as the wear he saw on my

teeth. (I didn't know I was grinding. He laughed and said, " Lemme put

it this way -- from what I see, either you've been grinding, or

you've been chewing Betel nuts! " )

He was very specific in saying that it was not TMJ surgery, but

rather for correction of a congenital, structural deficiency.

(Quasimodo, anybody?)

Cammie

> > > I have been told that I need orthognathic surgery for my

> > > crossbite/openbite to be improved. I would need about a year

of

> > > braces and then the surgery. I was wondering if anyone out

> there

> > > has insurance through Blue Cross Blue Shield and if they had

any

> > > problem getting insurance to cover this procedure. Any

feedback

> in

> > > connection to this would be very helpful. Thank you.

[Guest guest]

Hi --I had the surgery on July 15th and I have BCBS MA (Network Blue,

I am in western Mass) and my surgery was approved (but not

initially). It's been a long road to me getting this surgery, once

my dentist told me that I needed this he referred me to an

orthodontist who agreed (I then had 2 second opinions by other

orthodontists) and then off to an OS for confirmation. The

orthodontist wouldn't start the braces until he received approval for

the surgery because he didn't want to go through all the braces and

then had the surgery covered. Anyway, I agree with what others have

said it really depends on how the oral surgeon and orthodontist word

the letters requesting this surgery. i.e. do they state the case

that it is " medically necessary " not cosmetic.

I don't know the exact details of how it got approved, but I think

that BCBS MA may have some guidelines for what determines something

that cannot be corrected by braces alone. Basically my oral surgeon

and orthodontist took measurements and provided x-rays to the

insurance people demonstrating that my bite could not be corrected by

braces alone.

Once the surgery was approved, I demanded that the insurance company

send me and the OS and the orthodontist written confirmation of the

approval. They countered with " well, we have it in our electronic

records " and I said, " I'm sorry, but I don't have the utmost trust in

insurance companies, so please send me a written copy " and they did.

I swear, I kept that thing locked in our fire-safe box just in case

they decided to deny it after the fact.

Anyway, the good news is it was finally approved. My advice, is be

persistent with the insurance company and make sure your OS and your

ortho have experience dealing with insurance companies. Mine both

did and were wonderful at using the correct words and submitting all

the correct stuff in order to get the approval.

Hope this helps.

Helen

> I have been told that I need orthognathic surgery for my

> crossbite/openbite to be improved. I would need about a year of

> braces and then the surgery. I was wondering if anyone out there

> has insurance through Blue Cross Blue Shield and if they had any

> problem getting insurance to cover this procedure. Any feedback in

> connection to this would be very helpful. Thank you.