Re: New to the group - seeking some words of wisdom

[Guest guest]

I'd ask for the surgeon's help again, with this new insurance

company. They are the best ones to be able to explain that this is

medically necessary for you. Don't give up!

>

> Hello all,

>

> My name is and I live in South Carolina. This is my first

> time posting to or joining a group, so please go easy on me!

>

> I am currently in the midst of an insurance nightmare. A little

> background... I am a 31 year old woman. I first consulted an oral

> surgeon about 3 months ago, and after an initial workup, I was told

> that I need orthognathic surgery on my upper and lower jaw to bring

> them both forward, and also to widen my upper jaw. This wasn't

> surprising considering that all of my health problems seem point

> back to my anatomy. I have had braces twice, once when I was 11,

> and then again at 16. This is somthing that is long overdue as far

> as I am concerned, and I really don't have too many fears about the

> procedure (although that will probably change as the day draws

> near!). My problem is with insurance. I have group health

insurance

> through my employer and there is a specific exclusion for

> orthognathic surgery. The oral surgeon's office has gone to bat

for

> me, but to no avail. I am currently looking at a new insurance

plan

> that works like a group health plan, and there are certain

> exclusions about surgery on mandible or maxilla, but for cosmetic

> reasons.

>

> I apologize for the long-windedness, but my question is this: Does

> anyone have any suggestions or tips for me regarding the insurance

> debacle? I am open to any suggestions at this point. I was supposed

> to get my braces on last month, but stopped the process because of

> my financial concerns.

>

> I appreciate any and all feedback!

>

> Thanks -

[Guest guest]

I'd ask for the surgeon's help again, with this new insurance

company. They are the best ones to be able to explain that this is

medically necessary for you. Don't give up!

>

> Hello all,

>

> My name is and I live in South Carolina. This is my first

> time posting to or joining a group, so please go easy on me!

>

> I am currently in the midst of an insurance nightmare. A little

> background... I am a 31 year old woman. I first consulted an oral

> surgeon about 3 months ago, and after an initial workup, I was told

> that I need orthognathic surgery on my upper and lower jaw to bring

> them both forward, and also to widen my upper jaw. This wasn't

> surprising considering that all of my health problems seem point

> back to my anatomy. I have had braces twice, once when I was 11,

> and then again at 16. This is somthing that is long overdue as far

> as I am concerned, and I really don't have too many fears about the

> procedure (although that will probably change as the day draws

> near!). My problem is with insurance. I have group health

insurance

> through my employer and there is a specific exclusion for

> orthognathic surgery. The oral surgeon's office has gone to bat

for

> me, but to no avail. I am currently looking at a new insurance

plan

> that works like a group health plan, and there are certain

> exclusions about surgery on mandible or maxilla, but for cosmetic

> reasons.

>

> I apologize for the long-windedness, but my question is this: Does

> anyone have any suggestions or tips for me regarding the insurance

> debacle? I am open to any suggestions at this point. I was supposed

> to get my braces on last month, but stopped the process because of

> my financial concerns.

>

> I appreciate any and all feedback!

>

> Thanks -

[Guest guest]

,

It was an exclusion of my policy, too, but they paid for it. I have

BCBS of TN. I had to go through the grievance process and went to

the 3rd level before they approved it. If you change insurance,

just keep in mind that most have a 1 year waiting period for pre-

existing conditions. Good Luck.

Pam

>

> Hello all,

>

> My name is and I live in South Carolina. This is my first

> time posting to or joining a group, so please go easy on me!

>

> I am currently in the midst of an insurance nightmare. A little

> background... I am a 31 year old woman. I first consulted an oral

> surgeon about 3 months ago, and after an initial workup, I was

told

> that I need orthognathic surgery on my upper and lower jaw to

bring

> them both forward, and also to widen my upper jaw. This wasn't

> surprising considering that all of my health problems seem point

> back to my anatomy. I have had braces twice, once when I was 11,

> and then again at 16. This is somthing that is long overdue as

far

> as I am concerned, and I really don't have too many fears about

the

> procedure (although that will probably change as the day draws

> near!). My problem is with insurance. I have group health

insurance

> through my employer and there is a specific exclusion for

> orthognathic surgery. The oral surgeon's office has gone to bat

for

> me, but to no avail. I am currently looking at a new insurance

plan

> that works like a group health plan, and there are certain

> exclusions about surgery on mandible or maxilla, but for cosmetic

> reasons.

>

> I apologize for the long-windedness, but my question is this: Does

> anyone have any suggestions or tips for me regarding the insurance

> debacle? I am open to any suggestions at this point. I was

supposed

> to get my braces on last month, but stopped the process because of

> my financial concerns.

>

> I appreciate any and all feedback!

>

> Thanks -

[Guest guest]

,

It was an exclusion of my policy, too, but they paid for it. I have

BCBS of TN. I had to go through the grievance process and went to

the 3rd level before they approved it. If you change insurance,

just keep in mind that most have a 1 year waiting period for pre-

existing conditions. Good Luck.

Pam

>

> Hello all,

>

> My name is and I live in South Carolina. This is my first

> time posting to or joining a group, so please go easy on me!

>

> I am currently in the midst of an insurance nightmare. A little

> background... I am a 31 year old woman. I first consulted an oral

> surgeon about 3 months ago, and after an initial workup, I was

told

> that I need orthognathic surgery on my upper and lower jaw to

bring

> them both forward, and also to widen my upper jaw. This wasn't

> surprising considering that all of my health problems seem point

> back to my anatomy. I have had braces twice, once when I was 11,

> and then again at 16. This is somthing that is long overdue as

far

> as I am concerned, and I really don't have too many fears about

the

> procedure (although that will probably change as the day draws

> near!). My problem is with insurance. I have group health

insurance

> through my employer and there is a specific exclusion for

> orthognathic surgery. The oral surgeon's office has gone to bat

for

> me, but to no avail. I am currently looking at a new insurance

plan

> that works like a group health plan, and there are certain

> exclusions about surgery on mandible or maxilla, but for cosmetic

> reasons.

>

> I apologize for the long-windedness, but my question is this: Does

> anyone have any suggestions or tips for me regarding the insurance

> debacle? I am open to any suggestions at this point. I was

supposed

> to get my braces on last month, but stopped the process because of

> my financial concerns.

>

> I appreciate any and all feedback!

>

> Thanks -

[Guest guest]

Pam,

Thanks for your reply. I was hopeful that I would hear that from

someone. The insurance that I am considering is actually based out

of Tennesee, so maybe that is a good sign. Thanks again!

> >

> > Hello all,

> >

> > My name is and I live in South Carolina. This is my first

> > time posting to or joining a group, so please go easy on me!

> >

> > I am currently in the midst of an insurance nightmare. A little

> > background... I am a 31 year old woman. I first consulted an

oral

> > surgeon about 3 months ago, and after an initial workup, I was

> told

> > that I need orthognathic surgery on my upper and lower jaw to

> bring

> > them both forward, and also to widen my upper jaw. This wasn't

> > surprising considering that all of my health problems seem point

> > back to my anatomy. I have had braces twice, once when I was

11,

> > and then again at 16. This is somthing that is long overdue as

> far

> > as I am concerned, and I really don't have too many fears about

> the

> > procedure (although that will probably change as the day draws

> > near!). My problem is with insurance. I have group health

> insurance

> > through my employer and there is a specific exclusion for

> > orthognathic surgery. The oral surgeon's office has gone to bat

> for

> > me, but to no avail. I am currently looking at a new insurance

> plan

> > that works like a group health plan, and there are certain

> > exclusions about surgery on mandible or maxilla, but for

cosmetic

> > reasons.

> >

> > I apologize for the long-windedness, but my question is this:

Does

> > anyone have any suggestions or tips for me regarding the

insurance

> > debacle? I am open to any suggestions at this point. I was

> supposed

> > to get my braces on last month, but stopped the process because

of

> > my financial concerns.

> >

> > I appreciate any and all feedback!

> >

> > Thanks -

[Guest guest]

Pam,

Thanks for your reply. I was hopeful that I would hear that from

someone. The insurance that I am considering is actually based out

of Tennesee, so maybe that is a good sign. Thanks again!

> >

> > Hello all,

> >

> > My name is and I live in South Carolina. This is my first

> > time posting to or joining a group, so please go easy on me!

> >

> > I am currently in the midst of an insurance nightmare. A little

> > background... I am a 31 year old woman. I first consulted an

oral

> > surgeon about 3 months ago, and after an initial workup, I was

> told

> > that I need orthognathic surgery on my upper and lower jaw to

> bring

> > them both forward, and also to widen my upper jaw. This wasn't

> > surprising considering that all of my health problems seem point

> > back to my anatomy. I have had braces twice, once when I was

11,

> > and then again at 16. This is somthing that is long overdue as

> far

> > as I am concerned, and I really don't have too many fears about

> the

> > procedure (although that will probably change as the day draws

> > near!). My problem is with insurance. I have group health

> insurance

> > through my employer and there is a specific exclusion for

> > orthognathic surgery. The oral surgeon's office has gone to bat

> for

> > me, but to no avail. I am currently looking at a new insurance

> plan

> > that works like a group health plan, and there are certain

> > exclusions about surgery on mandible or maxilla, but for

cosmetic

> > reasons.

> >

> > I apologize for the long-windedness, but my question is this:

Does

> > anyone have any suggestions or tips for me regarding the

insurance

> > debacle? I am open to any suggestions at this point. I was

> supposed

> > to get my braces on last month, but stopped the process because

of

> > my financial concerns.

> >

> > I appreciate any and all feedback!

> >

> > Thanks -

[Guest guest]

Your surgeon should be your best ally in all this, as presumably

he/she has experience in dealing with the insurance companies. There

also may be an insurance specialist in his office who works with the

insurance companies daily.

For me, the key was my surgeon's telling them that I needed surgery

for repair of a congenital structural anomaly -- specifically, an

inadequate lower jaw. That it wasn't cosmetic, nor surgery for TMJ,

either.

Which it wasn't, for me.

Cammie

>

> Hello all,

>

> My name is and I live in South Carolina. This is my first

> time posting to or joining a group, so please go easy on me!

>

> I am currently in the midst of an insurance nightmare. A little

> background... I am a 31 year old woman. I first consulted an oral

> surgeon about 3 months ago, and after an initial workup, I was told

> that I need orthognathic surgery on my upper and lower jaw to bring

> them both forward, and also to widen my upper jaw. This wasn't

> surprising considering that all of my health problems seem point

> back to my anatomy. I have had braces twice, once when I was 11,

> and then again at 16. This is somthing that is long overdue as far

> as I am concerned, and I really don't have too many fears about the

> procedure (although that will probably change as the day draws

> near!). My problem is with insurance. I have group health

insurance

> through my employer and there is a specific exclusion for

> orthognathic surgery. The oral surgeon's office has gone to bat

for

> me, but to no avail. I am currently looking at a new insurance

plan

> that works like a group health plan, and there are certain

> exclusions about surgery on mandible or maxilla, but for cosmetic

> reasons.

>

> I apologize for the long-windedness, but my question is this: Does

> anyone have any suggestions or tips for me regarding the insurance

> debacle? I am open to any suggestions at this point. I was supposed

> to get my braces on last month, but stopped the process because of

> my financial concerns.

>

> I appreciate any and all feedback!

>

> Thanks -

[Guest guest]

Your surgeon should be your best ally in all this, as presumably

he/she has experience in dealing with the insurance companies. There

also may be an insurance specialist in his office who works with the

insurance companies daily.

For me, the key was my surgeon's telling them that I needed surgery

for repair of a congenital structural anomaly -- specifically, an

inadequate lower jaw. That it wasn't cosmetic, nor surgery for TMJ,

either.

Which it wasn't, for me.

Cammie

>

> Hello all,

>

> My name is and I live in South Carolina. This is my first

> time posting to or joining a group, so please go easy on me!

>

> I am currently in the midst of an insurance nightmare. A little

> background... I am a 31 year old woman. I first consulted an oral

> surgeon about 3 months ago, and after an initial workup, I was told

> that I need orthognathic surgery on my upper and lower jaw to bring

> them both forward, and also to widen my upper jaw. This wasn't

> surprising considering that all of my health problems seem point

> back to my anatomy. I have had braces twice, once when I was 11,

> and then again at 16. This is somthing that is long overdue as far

> as I am concerned, and I really don't have too many fears about the

> procedure (although that will probably change as the day draws

> near!). My problem is with insurance. I have group health

insurance

> through my employer and there is a specific exclusion for

> orthognathic surgery. The oral surgeon's office has gone to bat

for

> me, but to no avail. I am currently looking at a new insurance

plan

> that works like a group health plan, and there are certain

> exclusions about surgery on mandible or maxilla, but for cosmetic

> reasons.

>

> I apologize for the long-windedness, but my question is this: Does

> anyone have any suggestions or tips for me regarding the insurance

> debacle? I am open to any suggestions at this point. I was supposed

> to get my braces on last month, but stopped the process because of

> my financial concerns.

>

> I appreciate any and all feedback!

>

> Thanks -