Re: Re: Hi, I need orthognathic surgery.

[Guest guest]

I have the PPO plan already, and I believe the oral

surgeon files the claim...

--- mariagregbjdash <no_reply > wrote:

> I have a book that explains which way to make a

> claim. I am in

> Australia and things don't work the same here, but

> the book explains

> the following;

>

> How to write a letter to insurance company

>

> To Whom It May Concern;

>

> I have been following this young(age) yerl old man

> for some time now

> aat XYZ medical hospital. He has referred to me by

> his orthodontist

> Dr XYZ. My diagnoses demonstrated sever mandibular

> retrognathia and

> micrognathia. He had approximate discrepancy of over

> 1 cm between

> the two jaws. The maxilla itself was also

> hypoplastic in nature. He

> has difficulty in chewing and because of the

> specific nature of the

> bite, there is trauma occurring to the gingival

> tissues in the

> maxillary region ans instability in the dentition.

>

> Therefore, the diagnosis is maxillary ans mandibular

> hypoplasia and

> retrusion ( ICD-9 Diagnoses 524.01, 524.10). The

> recommended

> treatment to correct this deformity is bimaxillary

> surgery to

> consist of maxillary advancement with bone grafting

> ( CPT code

> 21145) and associated osteotomy ( CTP Code 21196)

> and a genioplasty

> reduction ( CPT code 21122).

>

> Your assistance in this matter is greatly

> appreciated.

>

> Apparently the best chance of getting surgery

> approved and getting

> the best surgeon if you go with PPO. As soon as you

> deide to go with

> the surgery, make a decision about HMO versus PPO

> plan.

>

> I hope the above makes sense to you as it does not

> makes sense to me.

>

> I am 12 days post op of top and bottom jae surgery

> in Perth

> Australia, and I feel fantastic.

>

> Good luck

>

>

>

>

__________________________________________________

[Guest guest]

--- ceast36532 <no_reply > wrote:

Thanks for the response. It was very informative.

Here's the thing though, medically, I believe there's

nothing wrong with me (I think). My mouth's normal

resting position is one inch open, and my teeth hang

out, but I don't think this can be considered medical,

can it? I don't have any pain or anything, but my

doctor did say my bit is a 9.9 out of 10 in severity,

andd I definitley exceed the 5mm requirement by

bluecross.

I do have to pay for my own braces $7000 right

there. If bluecross does approve, I have a $500

deductable, then I'm responsible for 20% of that

$40,000 the surgery costs. So either way, it's not

cheap

> You say:

>

> I would need to commit the next three years of my

> life

> > to braces,

>

> Hey, wearing braces isn't like entering a monastic

> order! And you

> need not spend your whole three years focused on

> braces -- probably

> you will not, in any case. That's just a step toward

> repair of

> something that isn't working! You will have to put

> up with the irks

> and quirks, the scrapes and sores and a modified

> diet. But what's

> the biggie in that?

>

> Sounds like you have more troubles than I did, and

> I'm grateful for

> every break I got in this process. It can be long,

> and frustrating.

> But really, it's not as bad as it sounds.

>

> You need a surgeon who will help you with the

> insurance company.

> Talk with a few more; some are more aggressive than

> others with

> insurance companies. Blue Cross/Blue Shield varies

> greatly from

> policy to policy and from state to state.

>

> Here, if you're denied, you can petition to have an

> appeal re-

> evaluated by a panel of oral and maxillofacial

> surgeons, who

> generally understand more about these procedures.

>

> If it's any comfort to you, BC/BS MEDICAL of Alabama

> covered my

> surgery completely. I'd file for preapproval, and

> appeal if they

> deny. But you'll need your surgeon's help to do

> that. (Submission of

> drawings, models, x-rays, etc.) Keep meticulous

> records of all

> submissions, conversations, appeals, etc. Build up a

> big file of

> postal receipts, get everything signed for and put

> down names and

> dates when you have conversations by phone. Some

> companies can be

> sneaky -- " losing " applications, etc. -- but mine

> was not. Mine was,

> in fact, princely about the whole thing.

>

> The braces were essentially on my tab, except for

> about $1200

> (lifetime cap from Dental insurance). (Ouch!)

>

> Other options: finance plans. Dental schools (which

> can be cheaper,

> if you don't mind having students work on you, under

> expert

> supervision. Be careful about this one, and be sure

> that you're

> comfy with what's going on.) Home equity loans,

> which, I'm told have

> some tax advantages (I'm no accountant).

> Negotiations with ortho,

> surgeon and hospital, if you're paying -- they'll

> sometimes cut the

> costs.

>

> Good wishes to you.

>

>

> > I went to my orthodontist to find out what's up

> with this jaw pain

> > I've been having lately. He examined me, then

> basically broke the

> bad

> > news to me: On a scale of 1-10, my severeness of

> my bite is a

> 9.9. I

> > have problems in both jaws, and I need corrective

> jaw surgery. He

> > explained that I would need to commit the next

> three years of my

> life

> > to braces, and have a surgery in between.

> >

> > Here's the bad part... he said my medical

> insurance might not cover

> > it. I'm really upset and worried over this. I'm

> having pain, and

> > they won't cover it? He could say nothing else but

> " well, that's

> the

> > world we live in Mike. "

> >

> > I'm insured with bluecross/blueshield. I looked it

> up, and they do

> > cover it if it's deemed medically necessary.

> >

> > Anybody have any knowledge/info on what I can do

> in my situation if

> > medical insurance doesn't cover? I'm afraid the

> pain will get worse

> > over time!

>

>

>

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[Guest guest]

Thank you tiffany, your response made my day

PS. Do the approve the surgery right away, or do I

have to wait a year with braces?

--- memphis_tiff wrote:

> > andd I definitley exceed the 5mm requirement by

> > bluecross.

>

> I have BCBS of Tennessee. I also exceeded the 5mm

> rule and they

> approved my surgery on the first try. I didn't

> really even talk to

> the OS about pain, he just looked at me, took molds,

> said they could

> fix me (underbite/crossbite/asymmetry) and sent me

> to an OD. Within

> three weeks I had approval for surgery from BCBS, so

> unless he made up

> a convincing letter stating pain (I assume not since

> we didn't really

> talk about it) then they approved it on measurements

> only.

>

> As far as cost goes, I have 90/10 coverage with

> them, so I will pay my

> $100 deductible, and 10% of surgery costs, but I

> have a max

> out-of-pocket of $1000, so as far as I know, the

> most I will be paying

> is $1000. (Anyone have a different opinion on this?

> I'm not very

> experienced with insurance, but I assume " max " means

> just that.) You

> may check into that on your policy though.

>

> Good luck!

> ~

>

>

>

__________________________________________________

[Guest guest]

Well the reason I ask is because I may change

employers before that happens, and I do wonder if I'm

approved now for it, if that carries over when I go to

a new job with different insurance.

--- memphis_tiff wrote:

> My surgery was approved independently of braces, and

> right away. As

> soon as I saw the OS, he sent me to the OD to get my

> teeth moving, and

> he submitted the claim to insurance, which they

> immediately approved.

>

> It was given a limitation of " 1 year or whenever my

> insurance year

> changed, " but that hasn't happened yet since I've

> only had to have

> braces for 8 months (got them on in Jan. 05).

> However the original

> plan was to have braces for a year, so my OS said

> they would just file

> for an extension in that situation.

>

> BCBS didn't cover any of my braces costs,

> unfortunately, but they did

> approve for me to have two nights covered in the

> hospital, which is

> the length my OS plans for me to stay there after

> surgery.

>

> I'm actually going in this Thursday for my surgery,

> so I'll keep

> updating post-op and let you know if anything

> happens billing-wise

> that is unexpected or what have you.

>

> ~

>

>

>

__________________________________________________

[Guest guest]

I work in human resources and with insurance companies

and the approval is contingent that you are still

covered at the time of service. If you do change

employers you could enroll in COBRA coverage but you'd

be paying the full cost plus 2% of the premiums.

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