Re: Question - Initiating Insurance Claims

[Guest guest]

From what I understand, insurance companies won't even consider a

request for pre approval until 6 months before the surgery date.

Which means that you'll probably have to go ahead and start your

orthodontic treatment before you know much about coverage for the

surgery.

The thing that I think really helped for my insurance approval was

that my surgeon sent me to a ENT doctor and a speech pathologist,

who both wrote letters to include in my request. I think that much

evidence, along with statements from my OD and OS really sold them

on it being medically necessary.

I'm getting upper, lower, genio and a septoplasty and nasal surgery

in March and the total comes to about $21,000. My insurance will

probably cover half. My braces were $7500 and insurance covered

$1500.

Hope this helps.

>

> Hi all,

>

> I had my first appt. with the OS a few weeks ago, and he sent me

to

> an OD to get started on the braces. It's going to be an 18+ month

> process for me, and the braces cost is coming out-of-pocket. I

meet

> with the OD again tomorrow to talk $$ and the plan. In the

> meantime, my OS was supposed to have written a letter to the

> insurance company to try and initiate approval for the surgery.

>

> Question is...should I wait until I hear from the OS/Insurance

> Company to get the braces put on, in case they don't cover the

cost

> of surgery? Can you guys throw me some total-cost numbers of what

> it might be if I had to pay surgery out-of-pocket? (He was talking

4

> procedures - 2 upper, 2 lower.)

>

> If it's too much and I can't afford it...then there's no use of

> getting the braces, I suppose. My OS assured me he didn't think

> there'd be a problem with them covering it, but I don't want to

get

> ahead of myself, but at the same time I'm antsy to get the show on

> the road!

>

> Also, how long should it take to hear back from the insurance

> company? I don't want to harass my OS office, but I'm curious as

to

> if he's sent the letter yet and when to expect a response.

>

> Thanks!

>

[Guest guest]

--- In orthognathicsurgerysupport , " memphis_tiff "

> Question is...should I wait until I hear from the OS/Insurance

> Company to get the braces put on, in case they don't cover the cost

> of surgery? Can you guys throw me some total-cost numbers of what

> it might be if I had to pay surgery out-of-pocket? (He was talking 4

> procedures - 2 upper, 2 lower.)

the problem might be that your employer could change insurance plans

and your pre-approval is nolonger valid. The preapproval is also only

normally valid for 12 months, so you have to plan ahead.

Below are uninsured, non-discounted costs for LeFort I, and Bilateral

saggital split osteotemy (what I had done)

Surgeon and assistant surgeon: $22,000

Anethestist: $1200

Hospital fees (Theatre, supplies, one night ICU): $22,000

At this point I'll be staring at the figures like I did and thinking

S*** that's a lot of money to find. Well, you can negotiate them lower

(esp. the hospital). You have to think that this is a long-term

investment in your future and taking out a loan to cover it over a

couple of years makes sense. I've an interest-free loan for most of

the cost that I'll refinance at the end of the year to a

lower-interest debt.

> If it's too much and I can't afford it...then there's no use of

> getting the braces, I suppose. My OS assured me he didn't think

> there'd be a problem with them covering it, but I don't want to get

> ahead of myself, but at the same time I'm antsy to get the show on

> the road!

Read your insurance coverage document.

My employers' insurance policies over the past 3+ years I have had

braces have had contractual exclusions for orthognathic surgery on

everyeon except dependants 19 and younger.

[this is 4 different polices with three carriers at two employers]

The age limit thing sucks becuase I didn't stop growing until my early

20's which is when my jaw deformity

/RjL