Guest guest Posted August 2, 2005 Report Share Posted August 2, 2005 Hey EJ, Welcome to the club. I know what you are talking about, I am 20 years old and when I got my braces on a year ago, and like you...all of the memories came flooding back (maybe part of it is the fact that I am going to the same orthodontists that I went to when I was younger!) What insurance do you have? I have Blue Cross Blue Sheild Federal and I am having surgery a week from Thursday. Here is what they approved: Madibular LeForte 1: Approved Genioplasty: Disapproved (Cosmetic) Septoplasty: Still waiting - my doctor's office said that unless you are having upper jaw surgery, they do not approve this because you are ungrouping so it is considered cosmetic, but my response to that was " how can something that helps me to breath better, be cosmetic? " I hope this helps! Austria --- J55 wrote: > Hey everyone... My name is EJ, I'm 25 years old, and > I just started > the process towards > getting upper and lower jaw surgery for my over bite > and TMJ. The > braces have been on a > little over a week and all the memories from my > childhood have come > flooding back! I had > braces on when I was younger for 5 years and just > about every other > form of orthodontic > treatment you can imagine, headgear, splints, > expanders, etc. So > obviously, I'm extatic. > > Right now I am in the process of working out the > insurance and was > wondering if anyone > had problems getting insurance to pay for this type > of surgery? > Currently, I am in a battle > of Health pointing at Dental and vice versa, and > both saying > basically it is an exclusion. > Either way I am going to get the surgery done, even > if it comes out > of my own pocket, but > just wanted to see if anyone had similar problems > and what they did > about it? > > As of right now, I am supposed to have the braces on > for about a > year, I will have surgery > next summer, and then hopefull get my braces off > before my 27th > birthday in February of > 07'. Hey, one can wish huh? I'm very excited to > start the > process towards a headache > free, closed smile, and just reading through some of > the posts on > here have answered > some questions I didn't even know I had. However, > some of those > 'post-op' pictures scare > the h*ll outta me! Anyway- thanks for the support > in advance, I > know it will help! > > -EJ:) > > > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2005 Report Share Posted August 2, 2005 Well, here's some good news. It's not universally true, but I asked my ortho when I started out for the second time (at age 56) whether he would need headgear. " Oh, we don't use headgear on adults, " he said. Whew! Not that I wouldn't have done it, if he'd told me to. But that was good news to me. As for battles with insurance companies -- for many people that's the most difficult part of the whole thing. Some companies give approval right away, based on repair of a congenital skeletal deficience, under medical. (That was my case. The dental paid a once-in-a- lifetime cap of $1,200 or so for the ortho; the rest was medical). Read your policy carefully, and ask for help from your surgeon and his insurance staff. If they deny you, appeal. My policy allows me to appeal for review by a panel of oral and maxillofacial surgeons, which I didn't have to do in this matter, but did in another. Appeal, appeal, and appeal again. Some insurance companies will " lose " submissions; some simply stall; some are very responsive. Mine (BC/BS of Alabama) was very fine, and they know my surgeon well - - and he and his staff know the ropes about how to submit it to them. Cammie > Hey everyone... My name is EJ, I'm 25 years old, and I just started > the process towards > getting upper and lower jaw surgery for my over bite and TMJ. The > braces have been on a > little over a week and all the memories from my childhood have come > flooding back! I had > braces on when I was younger for 5 years and just about every other > form of orthodontic > treatment you can imagine, headgear, splints, expanders, etc. So > obviously, I'm extatic. > > Right now I am in the process of working out the insurance and was > wondering if anyone > had problems getting insurance to pay for this type of surgery? > Currently, I am in a battle > of Health pointing at Dental and vice versa, and both saying > basically it is an exclusion. > Either way I am going to get the surgery done, even if it comes out > of my own pocket, but > just wanted to see if anyone had similar problems and what they did > about it? > > As of right now, I am supposed to have the braces on for about a > year, I will have surgery > next summer, and then hopefull get my braces off before my 27th > birthday in February of > 07'. Hey, one can wish huh? I'm very excited to start the > process towards a headache > free, closed smile, and just reading through some of the posts on > here have answered > some questions I didn't even know I had. However, some of those > 'post-op' pictures scare > the h*ll outta me! Anyway- thanks for the support in advance, I > know it will help! > > -EJ:) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2005 Report Share Posted August 2, 2005 EJ - Welcome to the club! Sounds like you and I (and others) will be going through this at about the same time. I'm 47 and have an underbite. I will be having a BSSO to set back my mandible and a LeFort to advance and drop down the front of my maxilla. I got my ceramic brackets on last Tuesday and my spacers were put on today. Next Tuesday my spacers will be removed and the bands, archwires, and ligatures/o-rings will be installed. My surgery will, also, be sometime next summer, after I have been in braces for ten months. This is my first time in braces. As for insurance, my plan thru my employer (a hospital) lists Orthognathic Surgery as an excluded benefit, so I will be paying for this out of my pocket. One of the great things about having the surgeon I have is that he has privileges at a small short-term hospital; he does the majority of his surgeries there, and the cost is one-quarter to one-third of the cost of the same procedures at my hospital/employer. (my hospital charges $10K per procedure (BSSO + LeFort= $20K, plus extra for hospital room)./ Again, EJ, Welcome to this very supportive and informative group. You won't be going thru this alone! ~~ Diane --- In orthognathicsurgerysupport , " J55 " <erinj55@y...> wrote: > Hey everyone... My name is EJ, I'm 25 years old, and I just started > the process towards > getting upper and lower jaw surgery for my over bite and TMJ. The > braces have been on a > little over a week and all the memories from my childhood have come > flooding back! I had > braces on when I was younger for 5 years and just about every other > form of orthodontic > treatment you can imagine, headgear, splints, expanders, etc. So > obviously, I'm extatic. > > Right now I am in the process of working out the insurance and was > wondering if anyone > had problems getting insurance to pay for this type of surgery? > Currently, I am in a battle > of Health pointing at Dental and vice versa, and both saying > basically it is an exclusion. > Either way I am going to get the surgery done, even if it comes out > of my own pocket, but > just wanted to see if anyone had similar problems and what they did > about it? > > As of right now, I am supposed to have the braces on for about a > year, I will have surgery > next summer, and then hopefull get my braces off before my 27th > birthday in February of > 07'. Hey, one can wish huh? I'm very excited to start the > process towards a headache > free, closed smile, and just reading through some of the posts on > here have answered > some questions I didn't even know I had. However, some of those > 'post-op' pictures scare > the h*ll outta me! Anyway- thanks for the support in advance, I > know it will help! > > -EJ:) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 3, 2005 Report Share Posted August 3, 2005 Thanks Austria, Diane and Cammie for the advice and the welcomes! I talked to my insurance agent yesterday and he wants me to get letters of 'necessity' from my OS and Orthodontist to send in with my records. My health insurance (Fortis…MetLife=dental) said they will review everything and basically tell us what they will and won't pay for… so fingers crossed it will be a substantial amount. I think it will be a case like yours Austria, where they will deem some necessary and some cosmetic. (Even though all of it is to stop the headaches and help me eat?!…whatever) However, my OS has told me that if insurance does not cover any procedure that he drops his fees and works with the hospital to do the same, so hopefully I will be in your boat Diane of only paying for about a third of the cost. It will be a long road to getting my records released and then submitting all the paperwork, and like you said Cammie, if I get turned down I'll appeal and appeal! Ahhh the joys of insurance…. Thanks for all the advice, it definitely helped dealing with the `no' people easier yesterday. Austria good luck with surgery! I hope it helps as much as I want mine too! And Cammie and Diane I look forward to chatting over the next year!!! -EJ:) > > > Hey everyone... My name is EJ, I'm 25 years old, and > > I just started > > the process towards > > getting upper and lower jaw surgery for my over bite > > and TMJ. The > > braces have been on a > > little over a week and all the memories from my > > childhood have come > > flooding back! I had > > braces on when I was younger for 5 years and just > > about every other > > form of orthodontic > > treatment you can imagine, headgear, splints, > > expanders, etc. So > > obviously, I'm extatic. > > > > Right now I am in the process of working out the > > insurance and was > > wondering if anyone > > had problems getting insurance to pay for this type > > of surgery? > > Currently, I am in a battle > > of Health pointing at Dental and vice versa, and > > both saying > > basically it is an exclusion. > > Either way I am going to get the surgery done, even > > if it comes out > > of my own pocket, but > > just wanted to see if anyone had similar problems > > and what they did > > about it? > > > > As of right now, I am supposed to have the braces on > > for about a > > year, I will have surgery > > next summer, and then hopefull get my braces off > > before my 27th > > birthday in February of > > 07'. Hey, one can wish huh? I'm very excited to > > start the > > process towards a headache > > free, closed smile, and just reading through some of > > the posts on > > here have answered > > some questions I didn't even know I had. However, > > some of those > > 'post-op' pictures scare > > the h*ll outta me! Anyway- thanks for the support > > in advance, I > > know it will help! > > > > -EJ:) > > > > > > > > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
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