Re: Which Insurance Plan would cover Orthognathic Surgery?

[Guest guest]

Are you looking at a dental or a medical policy? is my first

question.

The rule of thumb, although that's not set in stone, either, is, if

it deals with teeth, it's dental. If it deals with jaws, it's

medical. My dental policy paid only a portion of my orthodontic

care, and that's usual -- a lifetime cap of $1,000 or $1,500, or

somewhere in between. My medical policy paid none of that, but it

covered the surgery, as repair of a congenital skeletal defect,

which it was. Just as if I'd had one leg shorter than the other.

Most get surgical coverage under their MEDICAL insurance. (And I

can't believe that anybody would write a medical policy which would

exclude oral surgery for, let's say, cancer of the mouth; a jaw

broken in an auto accident, etc.) But there are a lot of wrinkles,

complications, etc., that can enter the picture, and I am expert in

none of them.

If you're getting this insurance through your employer, talk with

your human resources staff right away, and ask for a copy of the

policy. Which you then scour carefully, if you haven't already, to

see what it does and does not provide.

Next steps I'd suggest: Talk with your dentist. Talk with your

putative orthodontist. (I'm guessing that you haven't started this

yet, with the braces; if you have, talk with your caring ortho!)

Talk with your putative surgeon, or with all of them you're

interviewing (the person in their offices who deals with insurance

companies is also a good source of info, and don't be put off if the

doc sends you to such a person for advice).

The surgeon, in my experience, will be your best ally in getting

these procedures covered.

I do not think you're gonna find anybody who'll tell you " Sign up

with the Happy Smile Insurance Company, and we'll pay. " You're gonna

have to do a lot of homework about it, or move to Canada!

cammie

>

> Hi,

>

> I am new to this group, but was reading a lot of your posts in the

> last couple of days (and nights). I hope you can help me with my

> question:

>

> Does anybody know an insurance plan (preferably in GA) which would

> cover Orthognathic Surgery? I am in the process of getting new

> (individual) health insurance. I am not sure if I'd really need

> orthognathic surgery in the future. Still, I want to make sure

that I

> choose a plan which covers it.

>

> The BlueCross Blue Shield Georgia www.bcbsga.com excludes all oral

> surgery from their PPO plans. I could not find HMO for individuals.

>

> Thanks!

> Marie

[Guest guest]

Cammie,

Thank You for your kind reply and all the time you invested to help

me!

I am not working at the moment so there is no employer's plan and HR

department which could help me. I saved a little money to be able to

afford health insurance by myself and hope that they'd cover a surgery

if it would be a medical necessity in the future.

Yes, I should talk to a dentist or an orthodontist. I would even be

thrilled to talk to them, because they know the insurance game better

than anybody else (except the insurance companies of course ;-) ).

Still, I am scared that once something is diagnosed, they would make a

pre-existing condition out of it and I'd lower my chances that the

insurance company pays a potential surgery later. I did not have

anything diagnosed with my jaw, but have a strong feeling that surgery

may be necessary in the future.

I just feel scared going to an insurance broker and ask specifically

for a health plan which would cover oral surgery and (potentially) a

couple of months later get exactly that treatment. Wouldn't that be a

red flag?

Maybe there are independent insurance consultants for cases like that?

I would be happy to pay somebody to direct me to the right health

plan.

Thanks Again!

Marie

P.S: I want to get both - dental and health insurance.

> >

> > Hi,

> >

> > I am new to this group, but was reading a lot of your posts in the

> > last couple of days (and nights). I hope you can help me with my

> > question:

> >

> > Does anybody know an insurance plan (preferably in GA) which would

> > cover Orthognathic Surgery? I am in the process of getting new

> > (individual) health insurance. I am not sure if I'd really need

> > orthognathic surgery in the future. Still, I want to make sure

> that I

> > choose a plan which covers it.

> >

> > The BlueCross Blue Shield Georgia www.bcbsga.com excludes all oral

> > surgery from their PPO plans. I could not find HMO for

individuals.

> >

> > Thanks!

> > Marie