Guest guest Posted August 24, 2001 Report Share Posted August 24, 2001 In a message dated 8/24/01 8:54:04 PM Eastern Daylight Time, engineercarl@... writes: > Has anybody had success with having United > Healthcare Options PPO pay for DS surgery? My dr's office told me they had been having a lot of luck with United Healthcare. She said they were one of the ones who didn't give any problems...Not sure if this is the case for all United Healthcare policies, but she did mention it...good luck! Robyn Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 9, 2004 Report Share Posted September 9, 2004 Best suggestion: Trust your doc and his experience with insurance companies. Or hers. Second best suggestion: Take your benefit book to your lawyer, and trust your lawyer. Third, but maybe first best, suggestion: get everything in writing, and put it in your safe deposit box. Make notes like crazy, with names and dates, of everybody you talk with. I had no trouble getting approval -- in fact, my surgeon got it for me, bless him and his office staff. But these are simple ways to protect yourself. C. > I am applying for Blue Cross and Blue Shield insurance plan. There > is a question saying, > > 1. Arthritis, Bursitis, herniated, bulging or slipped disc, gout, > TMJ, any injury to, disease or disorder of the spine, back, knees, > jaw, bones muscles, or joints, bunions, joint replacement, > manipulation therapy? > > > 2. Has any person applying for coverage discussed or been advised to > have treatment, testing, counseling, therapy or surgery which has not > yet been performed? > > > I was wondering if the answer " YES/NO " would affect the coverage for > the surgery later on. > > My Dr told me to wait to answer those questions until I get re- > evaluated on Sept 20 and then perhaps the answers to the questions > would be more evident. I am not sure what he means. > > If anyone could give me suggestions, I would really appreciate it. > thank you. mako Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 9, 2004 Report Share Posted September 9, 2004 Best suggestion: Trust your doc and his experience with insurance companies. Or hers. Second best suggestion: Take your benefit book to your lawyer, and trust your lawyer. Third, but maybe first best, suggestion: get everything in writing, and put it in your safe deposit box. Make notes like crazy, with names and dates, of everybody you talk with. I had no trouble getting approval -- in fact, my surgeon got it for me, bless him and his office staff. But these are simple ways to protect yourself. C. > I am applying for Blue Cross and Blue Shield insurance plan. There > is a question saying, > > 1. Arthritis, Bursitis, herniated, bulging or slipped disc, gout, > TMJ, any injury to, disease or disorder of the spine, back, knees, > jaw, bones muscles, or joints, bunions, joint replacement, > manipulation therapy? > > > 2. Has any person applying for coverage discussed or been advised to > have treatment, testing, counseling, therapy or surgery which has not > yet been performed? > > > I was wondering if the answer " YES/NO " would affect the coverage for > the surgery later on. > > My Dr told me to wait to answer those questions until I get re- > evaluated on Sept 20 and then perhaps the answers to the questions > would be more evident. I am not sure what he means. > > If anyone could give me suggestions, I would really appreciate it. > thank you. mako Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 11, 2004 Report Share Posted September 11, 2004 C, Thank you for your good advice!! I will follow it. I will get a notebook and write down everything when I talk to my Dr, lawer, etc. Hope my Dr is like yours. thank you! Mako > > I am applying for Blue Cross and Blue Shield insurance plan. There > > is a question saying, > > > > 1. Arthritis, Bursitis, herniated, bulging or slipped disc, gout, > > TMJ, any injury to, disease or disorder of the spine, back, knees, > > jaw, bones muscles, or joints, bunions, joint replacement, > > manipulation therapy? > > > > > > 2. Has any person applying for coverage discussed or been advised > to > > have treatment, testing, counseling, therapy or surgery which has > not > > yet been performed? > > > > > > I was wondering if the answer " YES/NO " would affect the coverage > for > > the surgery later on. > > > > My Dr told me to wait to answer those questions until I get re- > > evaluated on Sept 20 and then perhaps the answers to the questions > > would be more evident. I am not sure what he means. > > > > If anyone could give me suggestions, I would really appreciate it. > > thank you. mako Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 11, 2004 Report Share Posted September 11, 2004 C, Thank you for your good advice!! I will follow it. I will get a notebook and write down everything when I talk to my Dr, lawer, etc. Hope my Dr is like yours. thank you! Mako > > I am applying for Blue Cross and Blue Shield insurance plan. There > > is a question saying, > > > > 1. Arthritis, Bursitis, herniated, bulging or slipped disc, gout, > > TMJ, any injury to, disease or disorder of the spine, back, knees, > > jaw, bones muscles, or joints, bunions, joint replacement, > > manipulation therapy? > > > > > > 2. Has any person applying for coverage discussed or been advised > to > > have treatment, testing, counseling, therapy or surgery which has > not > > yet been performed? > > > > > > I was wondering if the answer " YES/NO " would affect the coverage > for > > the surgery later on. > > > > My Dr told me to wait to answer those questions until I get re- > > evaluated on Sept 20 and then perhaps the answers to the questions > > would be more evident. I am not sure what he means. > > > > If anyone could give me suggestions, I would really appreciate it. > > thank you. mako Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 13, 2004 Report Share Posted October 13, 2004 Exactly. And usually only the MEDICAL pays for the surgery. One oral surgeon told me, " If it's teeth, it's deemed dental. If it's jaws, it's deemed medical. " I found out, in another context, that such is not always true. But I had to write my own appeal, and get the backing of some docs' whose medical procedures had brought about the problem. I'm getting ready to tackle the problem again; had success once, but I'm gonna push it for a second try. I figure I lose some of my time, and a 37-cent stamp, and the worst ruling they can make leaves me no worse off than I am if I don't bother, so why not ask? Cammie > > Nope, but my DENTAL insurance paid up to its lifetime cap, which is a > ridiculous $1,000 or $1,200... Have you ever heard of anybody having > ortho for that price, or even twice that price? I haven't. > > C. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 13, 2004 Report Share Posted October 13, 2004 Exactly. And usually only the MEDICAL pays for the surgery. One oral surgeon told me, " If it's teeth, it's deemed dental. If it's jaws, it's deemed medical. " I found out, in another context, that such is not always true. But I had to write my own appeal, and get the backing of some docs' whose medical procedures had brought about the problem. I'm getting ready to tackle the problem again; had success once, but I'm gonna push it for a second try. I figure I lose some of my time, and a 37-cent stamp, and the worst ruling they can make leaves me no worse off than I am if I don't bother, so why not ask? Cammie > > Nope, but my DENTAL insurance paid up to its lifetime cap, which is a > ridiculous $1,000 or $1,200... Have you ever heard of anybody having > ortho for that price, or even twice that price? I haven't. > > C. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2004 Report Share Posted November 4, 2004 How did you get them to cover the genio? S. Re: Insurance I had upper/lower/genio on June 7th, and it was completely covered by Blue Cross/Blue Shield of CA - all 78,000 of it (including my genioplasty)! All I had to pay was my deductible of $500 a night for the hospital stay. My surgery was pre-authorized on the first submission. Hope this helps! Shayna > > Did you guys have any trouble getting your surgery approved by your > Medical Insurance? I have BC/BS of California and I don't know if > they will cover my surgery. Does anyone know? > > Second question, how much further do I have to go when my > Orthodontist is already closing the spaces between my teeth and he > said to me that his getting me ready for Surgery. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2004 Report Share Posted November 4, 2004 How did you get them to cover the genio? S. Re: Insurance I had upper/lower/genio on June 7th, and it was completely covered by Blue Cross/Blue Shield of CA - all 78,000 of it (including my genioplasty)! All I had to pay was my deductible of $500 a night for the hospital stay. My surgery was pre-authorized on the first submission. Hope this helps! Shayna > > Did you guys have any trouble getting your surgery approved by your > Medical Insurance? I have BC/BS of California and I don't know if > they will cover my surgery. Does anyone know? > > Second question, how much further do I have to go when my > Orthodontist is already closing the spaces between my teeth and he > said to me that his getting me ready for Surgery. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2004 Report Share Posted November 4, 2004 My surgeon's office handled the whole thing. I think I just got lucky! I was quite amazed myself. Shayna > > > > Did you guys have any trouble getting your surgery approved by > your > > Medical Insurance? I have BC/BS of California and I don't know if > > they will cover my surgery. Does anyone know? > > > > Second question, how much further do I have to go when my > > Orthodontist is already closing the spaces between my teeth and he > > said to me that his getting me ready for Surgery. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2004 Report Share Posted November 4, 2004 My surgeon's office handled the whole thing. I think I just got lucky! I was quite amazed myself. Shayna > > > > Did you guys have any trouble getting your surgery approved by > your > > Medical Insurance? I have BC/BS of California and I don't know if > > they will cover my surgery. Does anyone know? > > > > Second question, how much further do I have to go when my > > Orthodontist is already closing the spaces between my teeth and he > > said to me that his getting me ready for Surgery. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2004 Report Share Posted November 4, 2004 Shayna, Im just curious was the $78,000 the surgeons fee for all of your procedures? My daugher had all those same procedures and our surgeons fee was $30,000. that's a big difference between Calif and NY! Re: Insurance My surgeon's office handled the whole thing. I think I just got lucky! I was quite amazed myself. Shayna > > > > Did you guys have any trouble getting your surgery approved by > your > > Medical Insurance? I have BC/BS of California and I don't know if > > they will cover my surgery. Does anyone know? > > > > Second question, how much further do I have to go when my > > Orthodontist is already closing the spaces between my teeth and he > > said to me that his getting me ready for Surgery. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2004 Report Share Posted November 4, 2004 Shayna, Im just curious was the $78,000 the surgeons fee for all of your procedures? My daugher had all those same procedures and our surgeons fee was $30,000. that's a big difference between Calif and NY! Re: Insurance My surgeon's office handled the whole thing. I think I just got lucky! I was quite amazed myself. Shayna > > > > Did you guys have any trouble getting your surgery approved by > your > > Medical Insurance? I have BC/BS of California and I don't know if > > they will cover my surgery. Does anyone know? > > > > Second question, how much further do I have to go when my > > Orthodontist is already closing the spaces between my teeth and he > > said to me that his getting me ready for Surgery. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 19, 2004 Report Share Posted December 19, 2004 I recently received a denial statement from CareFirst stating that they denied my initial visit with my Oral Surgeon because it was the Second Oral Evaluation I had in a year. They stated that my first Oral Evaluation was from a regular dental cleaning I had back in March with my general dentist. I told them that I felt this was unfair because my insurance covers 2 dental cleanings a year and it wasn't an oral evaluation it was a regular dental cleaning. They informed me that every dental cleaning is considered an oral evaluation. I then went on the explain that the OS visit was for an evaluation for surgery. They stated that they consider it the same. Has anyone had this problem and what advice can you give to correct? The CareFirst Rep that I talked with did inform me that she didn't see any problem with them covering the surgery as long as the OS stated that it was medically necessary which was good news, but I still don't see how they can state that a dental cleaning and OS evaluation is considered the same. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 19, 2004 Report Share Posted December 19, 2004 I recently received a denial statement from CareFirst stating that they denied my initial visit with my Oral Surgeon because it was the Second Oral Evaluation I had in a year. They stated that my first Oral Evaluation was from a regular dental cleaning I had back in March with my general dentist. I told them that I felt this was unfair because my insurance covers 2 dental cleanings a year and it wasn't an oral evaluation it was a regular dental cleaning. They informed me that every dental cleaning is considered an oral evaluation. I then went on the explain that the OS visit was for an evaluation for surgery. They stated that they consider it the same. Has anyone had this problem and what advice can you give to correct? The CareFirst Rep that I talked with did inform me that she didn't see any problem with them covering the surgery as long as the OS stated that it was medically necessary which was good news, but I still don't see how they can state that a dental cleaning and OS evaluation is considered the same. Quote Link to comment Share on other sites More sharing options...
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