Re: Hi, I need orthognathic surgery.

[Guest guest]

No Guarantees but from what i understand

if your oral surgeon submits your xrays and

a letter stating that this is congential

jaw condition it might make a big difference

i would contact a oral surgeon that you might

use and ask there staff how to submit these for

getting approval. thats where i would start

[Guest guest]

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]

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!

[Guest guest]

> 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]

Have you looked at any of the common problems this can cause. I

denied surgery x2 and did not think I was having any problems.

However, in hind sight I was. I didn't know I was. Once the

problems escalated, I went to a third consult (this was a total of

12yrs in the making) and am now ready for surgery. Problem is now,

everything is so bad that my regular OD won't do the braces and has

said that it is over their heads. Now I am waiting to see the docs

at UNC. I wish I had done this yrs ago.

Rene`

> > > 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!

> >

> >

> >

>

>

>

>

> __________________________________

> Yahoo! Mail - PC Magazine Editors' Choice 2005

> http://mail.yahoo.com

[Guest guest]

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.

~