Re: Orthognathic - Second Time

[Guest guest]

Sorry to here about that Who is your insurance provider? Perhaps you could

get small portion of it covered through by having your surgeon and ortho. write

letters to your insurance company?

cosmid92671 wrote:Hello all --

About a year ago, I have upper (3 - piece) and lower jaw surgery.

I've noticed that my upper jaw is now no longer under my nose and my

right side of my face looks puffy. I saw my Ortho today, and he

said it's probably because that my upper jaw is rotated and pushing

out the tissue on my right side of my face. Anyway, I've since

changed employers and I am going back to my Surgeon to see about

getting it redone.

However, I looked at my insurance today, and I saw this:

No amount will be payable for:

Osteotomy, orthognathic surgery, maxillofacial orthopedics, or

related treatment for defomities caused by anything other than

cancer or trauma.

So, it doesn't look good that I'll get this redone huh? That

sucks. :-(

[Guest guest]

so does that mean they don't cover any birth defects. I still think

you should see the os and talk with your insurance. I wish you luck

and hope soemthing can be worked out.

Beth

> No amount will be payable for:

>

> Osteotomy, orthognathic surgery, maxillofacial orthopedics, or

> related treatment for defomities caused by anything other than

> cancer or trauma.

[Guest guest]

Hi Cosmid,

Well, since this is a surgical complication from a previously

covered procedure (I realize it is probably a different insurance

company, but if you were seamless in your coverage, this might make

a difference), it might be more akin to a recent " injury " patient,

using the surgery as the injury date. I would ask for a

preauthorization on those grounds, since it is true that a srugical

complication is not exactly like a birth defect they would be

covering for the first time.

Since they do cover people who have facial accidents, and your

covered procedure was similar to an injury in that way, I think you

might have a good chance of going it covered on that avenue. But

get it preauthorized or refused in writing. Then let us know what

you find out. There may be some other steps you can take in this

situation if it is refused.

Hugs,

Fran

> Hello all --

>

> About a year ago, I have upper (3 - piece) and lower jaw surgery.

> I've noticed that my upper jaw is now no longer under my nose and

my

> right side of my face looks puffy. I saw my Ortho today, and he

> said it's probably because that my upper jaw is rotated and

pushing

> out the tissue on my right side of my face. Anyway, I've since

> changed employers and I am going back to my Surgeon to see about

> getting it redone.

>

>

> However, I looked at my insurance today, and I saw this:

>

> No amount will be payable for:

>

> Osteotomy, orthognathic surgery, maxillofacial orthopedics, or

> related treatment for defomities caused by anything other than

> cancer or trauma.

>

> So, it doesn't look good that I'll get this redone huh? That

> sucks. :-(

[Guest guest]

Hi Cosmid:

Have you been back to see your surgeon yet? I would do this and

have them file the paperwork and see what your insurance says. I had

upper and lower almost 2 years ago and have been recommended by

another surgeon to have it redone. My upper was moved to far, so

now I don't show enough teeth and my bite is off on one side. Just

curious, were you wired shut or did you have the plates to hold your

bones in place. Has this movement caused any breathing problems

through your nose? Anyway, I also have a different insurance and

says much of the same thing, but after filing it they declined

because of pre-exisiting condition, but said that I could refile

after a year which will be next Feb, so I still have some hope.

mac

> > Hello all --

> >

> > About a year ago, I have upper (3 - piece) and lower jaw

surgery.

> > I've noticed that my upper jaw is now no longer under my nose

and

> my

> > right side of my face looks puffy. I saw my Ortho today, and he

> > said it's probably because that my upper jaw is rotated and

> pushing

> > out the tissue on my right side of my face. Anyway, I've since

> > changed employers and I am going back to my Surgeon to see about

> > getting it redone.

> >

> >

> > However, I looked at my insurance today, and I saw this:

> >

> > No amount will be payable for:

> >

> > Osteotomy, orthognathic surgery, maxillofacial orthopedics, or

> > related treatment for defomities caused by anything other than

> > cancer or trauma.

> >

> > So, it doesn't look good that I'll get this redone huh? That

> > sucks. :-(