Starting treatment before insurance approval!?

December 23, 2004

Insurance denied my first attempt to cover lower jaw surgery, but

I'm going to appeal this denial soon. Have many of you out there

started treatment with braces without first securing the insurance

for surgery? My insurance states that it will cover " orthognathic

surgery that is medically necessary " so I hope it's only a matter of

time until they approve it. Any feedback would be great!

-nate

December 23, 2004

Insurance denied my first attempt to cover lower jaw surgery, but

I'm going to appeal this denial soon. Have many of you out there

started treatment with braces without first securing the insurance

for surgery? My insurance states that it will cover " orthognathic

surgery that is medically necessary " so I hope it's only a matter of

time until they approve it. Any feedback would be great!

-nate

December 23, 2004

I did. My ortho agreed to my eager entreaties, as he knew that I

needed ortho work, whether or not I eventually had the surgery, which

he strongly recommended.

He also had every reason to believe that I would get the approval.

He's worked for years with this surgeon, who has enough experience to

know what Blue Cross and Blue Shield here are likely to do. The ortho

actually told me that usually they are covered under the medical

policy, which my surgeon confirmed.

My surgeon prepared the application -- and it was extensive, with

models, films, drawings etc. He also made a very specific statement

of the medical necessity.

Cammie

>

> Insurance denied my first attempt to cover lower jaw surgery, but

> I'm going to appeal this denial soon. Have many of you out there

> started treatment with braces without first securing the insurance

> for surgery? My insurance states that it will cover " orthognathic

> surgery that is medically necessary " so I hope it's only a matter

of

> time until they approve it. Any feedback would be great!

>

> -nate

December 23, 2004

I did. My ortho agreed to my eager entreaties, as he knew that I

needed ortho work, whether or not I eventually had the surgery, which

he strongly recommended.

He also had every reason to believe that I would get the approval.

He's worked for years with this surgeon, who has enough experience to

know what Blue Cross and Blue Shield here are likely to do. The ortho

actually told me that usually they are covered under the medical

policy, which my surgeon confirmed.

My surgeon prepared the application -- and it was extensive, with

models, films, drawings etc. He also made a very specific statement

of the medical necessity.

Cammie

>

> Insurance denied my first attempt to cover lower jaw surgery, but

> I'm going to appeal this denial soon. Have many of you out there

> started treatment with braces without first securing the insurance

> for surgery? My insurance states that it will cover " orthognathic

> surgery that is medically necessary " so I hope it's only a matter

of

> time until they approve it. Any feedback would be great!

>

> -nate

December 23, 2004

Thanks Cammie. I also have Blue Cross Blue Shield, but I have them

through Massachusetts. I don't know if this makes a difference, but

I am hopeful because the term " orthognathic surgery " is listed under

the benefits. I guess it's just up to my surgeon to make a

convincing arguement. Did you get approval on the first try?

-nate

December 23, 2004

Thanks Cammie. I also have Blue Cross Blue Shield, but I have them

through Massachusetts. I don't know if this makes a difference, but

I am hopeful because the term " orthognathic surgery " is listed under

the benefits. I guess it's just up to my surgeon to make a

convincing arguement. Did you get approval on the first try?

-nate

December 24, 2004

I think, but don't know, that each policy is its own separate entity,

and that what some cover, others do not. Do read your policy

carefully, along with whatever other info you can get about their

ideas on covering/not covering things.

And certainly they vary from state to state.

Yes, I think what the surgeon submits (and the amount of supporting

detail) can make a huge difference. If your surgeon has someone in

his office who deals with insurance companies, why not show them your

policy and ask for help. Believe me -- they are your best allies.

And yes, I was approved on the first submission, for six months.

Since I didn't get ready that quickly, my surgeon resubmitted shortly

before the surgery, and again won the approval.

Good wishes to you!

Cammie

>

> Thanks Cammie. I also have Blue Cross Blue Shield, but I have them

> through Massachusetts. I don't know if this makes a difference,

but

> I am hopeful because the term " orthognathic surgery " is listed

under

> the benefits. I guess it's just up to my surgeon to make a

> convincing arguement. Did you get approval on the first try?

>

> -nate

December 24, 2004

I think, but don't know, that each policy is its own separate entity,

and that what some cover, others do not. Do read your policy

carefully, along with whatever other info you can get about their

ideas on covering/not covering things.

And certainly they vary from state to state.

Yes, I think what the surgeon submits (and the amount of supporting

detail) can make a huge difference. If your surgeon has someone in

his office who deals with insurance companies, why not show them your

policy and ask for help. Believe me -- they are your best allies.

And yes, I was approved on the first submission, for six months.

Since I didn't get ready that quickly, my surgeon resubmitted shortly

before the surgery, and again won the approval.

Good wishes to you!

Cammie

>

> Thanks Cammie. I also have Blue Cross Blue Shield, but I have them

> through Massachusetts. I don't know if this makes a difference,

but

> I am hopeful because the term " orthognathic surgery " is listed

under

> the benefits. I guess it's just up to my surgeon to make a

> convincing arguement. Did you get approval on the first try?

>

> -nate

December 24, 2004

I have Blue Cross/Blue Shield of North Carolina and the denied me 4

times before finally " reconsidering " . I did start out with my braces

before getting approved though. I think a lot of times they want to

see how far you will go before supporting you like they are supposed

to. Keep on them and keep on your OS's office so that they will keep

sending in what the insurance company needs. I also went to 2 OS

before gettting approved. WIth the first OS I got denied 2 times and

I decided that the OS was not giving me the support I needed so I

switched OS's and they started a whole new claim. Insurance denied

me 2 times there. I dont know what their problem was, but finally

they decided to " take another look at my files and information " and

they approved me after 2 years of hassle.

You too will get through this!

orthognathicsurgerysupport , " nlacasse27 "

<nathan27@m...> wrote:

>

> Insurance denied my first attempt to cover lower jaw surgery, but

> I'm going to appeal this denial soon. Have many of you out there

> started treatment with braces without first securing the insurance

> for surgery? My insurance states that it will cover " orthognathic

> surgery that is medically necessary " so I hope it's only a matter

of

> time until they approve it. Any feedback would be great!

>

> -nate

December 24, 2004