Guest guest Posted April 2, 2005 Report Share Posted April 2, 2005 , Such denials are quite common. My husband's employer, for example, has excluded any treatment for TMJ from covered benefits, thus, my surgery was denied since I came to the OS with a complaint of TMJ problems. Unfortunately, if orthognathic surgery is an excluded benefit, from what I know, there is pretty much nothing you can do to get it covered unless you switch insurance plans. The way it works is if you had liability only coverage on your car, and then you got in a car accident which was your fault, and wanted your insurance to pay to fix your car - they wouldn't do it because you never bought coverage for such occasion. Irene. > > anyone ever deal with a situation where the insurance company denies a > pre-auth due to the procedure (lefort I) not a covered benefit on the > insurance plan? Basically what the OS insurance rep told me was that > my employer had excluded this procedure (orthognathic surgery) from > the insurance plan. So the insurance basically has no choice but to > deny it. This doesn't seem like the normal insurance denial, just > wondering if this happened to anyone else out there. Quote Link to comment Share on other sites More sharing options...
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