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Re: insurance coverage

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Hi Vinayak,

Insurance policies vary widely even with the same carrier. You

might check with the human resourses department or medical claims

rep for your policy regarding orthognathic surgery. Sometimes it is

an excluded benefit. That means no amount of contesting will

provide coverage. If it is not an excluded benefit, your OD and OS

can provide written info to your insurance as the the medical

necessity of your surgery. It is good to get it preauthorized in

writing from your insurance before you begin treatment, as they will

try to delay your request beyond the time the payments are due.

Then getting reimbursed is a real nightmare!! So try to get it

preauthorized if possible. Let us know what you find out!

Fran

> Hi all,

>

> My name is Vinayak and I'm a recent college graduate who is going

to

> start work in New York City in a few weeks. I have been told that

my

> medical benefits are provided by CIGNA. However, I noticed on this

> message board that several people have recently been denied by

CIGNA.

> Since I just began a new round of treatment, my estimated surgery

> date is about a year away. Any advice on what options I have with

> regards to insurance coverage? Has anyone had any good results

from

> CIGNA? Is there any supplemental insurance I can purchase on the

> side? How do you go about contesting a claim that they deny?

>

> I just would like to be prepared with regards to the finances. The

> orthodontic treatment in the first year alone will cost about

$15,000

> (NYC is ridiculously expensive!) and my insurance only covers about

> 10% max of that. Plus, I may have to get chin/nose procedures that

> are not covered, so I would like to minimize all possible expenses

on

> the surgery itself. Thanks so much for any input.

>

> Vinayak

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  • 1 month later...

Thank you for posting this. I was given similar advice for here in

Virginia. Something else for me to do! :)

Thank you again.

- H

> I'm not sure what other states do in regards to RSS but in Minnesota

> they have a program called TEFRA (part of MA) that covers all the

costs

> for my RSS daughter, including growth hormone and needles. When I

had

> her on a regular HMO, the co-pays literally bankrupted. I applied

for

> MA for my daughter, got her certified as disabled due to her feeding

> needs and have had no worries since.

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