Re: Hi - I am New Here, But Second Go-Around w/ Treatment

[Guest guest]

Hi Cindy,

Welcome to the group! You are definitely allowed to feel frustrated

and you have more than good reason to! I feel frustrated just hearing

your story about the approval and already so much time with braces

just to end back up in them again. Wow! Isn't it great (yea right)

how things work that way, you are at the mercy of others to do right

by you and things end up like this...... I hope that you will be able

to find a way to get the surgery approved.... Maybe a statement from

the original surgeon that ultimately advised against the surgery

stating that much, along with an additional statement by your current

surgeon assessing the whole situation.. " that you should have

originially recieved the surgery, they treated your case

incorrectly/poorly and now you are still need, as you needed

originally, that surgery to correct this problem finally " . I don't

know anything about tricare however and don't know how to help you

with that angle. If no one posts back about it this time, try again,

because messages sometimes get lost... I know there are other members

in the group that are military and may be able to help you. How often

they check in here, I'm not sure thought. I wish I could help.

Anyway, I wish you the best and we're all here to help/support you as

you undertake this process all over again. I know that you are not

alone in having to fight for coverage for the surgery. That battle

has been and continues to be waged on many fronts.... Good luck with

everything and keep us posted how it goes for you. And Hang in there!

And you're allowed to not always be happy!

Katja

> Hi All,

>

> I am a 38 year old woman facing orthognathic surgery - again. Let

me

> explain. Five years ago I started ortho treatment on my upper and

> lower jaws. After 2 years in braces, the ortho and the oral

surgeon

> both thought that the problem had been corrected orthodontically

and

> that I was not going to need surgery. So, after all of the

fighting

> and appeals to the insurance company to have the procedure approved

> (which it finally was), I never went through with the surgery (at

the

> surgeon's recommendation!).

>

> So, guess what? Here I am 3 years later, back in another ortho's

> office (we moved - we are military) being told that all of the

> treatment has regressed and I am needing surgery - sooner better

than

> later.

>

> I am so frustrated. Like I said, we are military and having the

> initial ortho and surgery approved was such a long, difficult,

drawn-

> out process. I am dreading having to go through that again - I

think

> I dread that even more than I am dreading having braces put back

on.

> People here aren't too optimistic that we will even be able to get

a

> second approval since I did not go through with the surgery the

first

> time.

>

> Is anyone else here working through TriCare? I would love any

advice

> that I can get on how to re-work this whole approval process. Like

I

> said, I have already visited the ortho and I have a referral to an

> oral surg for a consultation - I have to call him first thing in

the

> AM to see if I can get in to his office quickly to get this ball

> rolling.

>

> We are kind of working on a time-crunch. We are slated to move

again

> next summer and I would like to have as much of this done as

possible

> before we go. My ortho said he thought we could get through the

> surgery and partially into the post-op before I have to move, but

we

> would have to start in the next couple of weeks.

>

> Sorry about the long post - I appreciate your patience. I really

am

> a very happy person normally, but this is weighing heavily on me

> tonight.

>

> Cindy

[Guest guest]

Cindy, I had a similar experience. Call TriCare and speak with a

supervisor in the claims dept. Tell the sup. that you were approved

once prior. ask them to pull up your file. Have all the info you

know in front of you(oral surgeon's name,# adress,ortho name, #

adress,prior ortho info. if you had diff ortho, prior surgeon if

diff.)Ask the rep to fax or E-mail any approval info they have to

you AND your surgeon give them a fax# if need be> Stress to them

you have a functional issue and need surgery in order to be

corrected! Ask them dates of when info will be available-they will

probably say someone needs to review your account. Call them every

couple of days and let them know this is important. Have your

Surgeon resubmit surgical info for approval NOW it can take 6wks to

be processed. Good luck and ask everyone(Surgeon, Surgeon's billing

Dept., Ortho, and Tri-Care)LOTS of questions and ask how you can

help speed the process along. You'll be shocked at info you can get

by only asking. Hope this helps

> Hi All,

>

> I am a 38 year old woman facing orthognathic surgery - again. Let

me

> explain. Five years ago I started ortho treatment on my upper and

> lower jaws. After 2 years in braces, the ortho and the oral

surgeon

> both thought that the problem had been corrected orthodontically

and

> that I was not going to need surgery. So, after all of the

fighting

> and appeals to the insurance company to have the procedure

approved

> (which it finally was), I never went through with the surgery (at

the

> surgeon's recommendation!).

>

> So, guess what? Here I am 3 years later, back in another ortho's

> office (we moved - we are military) being told that all of the

> treatment has regressed and I am needing surgery - sooner better

than

> later.

>

> I am so frustrated. Like I said, we are military and having the

> initial ortho and surgery approved was such a long, difficult,

drawn-

> out process. I am dreading having to go through that again - I

think

> I dread that even more than I am dreading having braces put back

on.

> People here aren't too optimistic that we will even be able to get

a

> second approval since I did not go through with the surgery the

first

> time.

>

> Is anyone else here working through TriCare? I would love any

advice

> that I can get on how to re-work this whole approval process.

Like I

> said, I have already visited the ortho and I have a referral to an

> oral surg for a consultation - I have to call him first thing in

the

> AM to see if I can get in to his office quickly to get this ball

> rolling.

>

> We are kind of working on a time-crunch. We are slated to move

again

> next summer and I would like to have as much of this done as

possible

> before we go. My ortho said he thought we could get through the

> surgery and partially into the post-op before I have to move, but

we

> would have to start in the next couple of weeks.

>

> Sorry about the long post - I appreciate your patience. I really

am

> a very happy person normally, but this is weighing heavily on me

> tonight.

>

> Cindy

[Guest guest]

Hi Cindy,

All I can say is Tricare, Tricare, Tricare..... They always seem to

be an uphill battle. My OS says that they have only done this

through Tricare 4 times, but have not had a problem. I hope that is

so. I go for my ortho consult on Monday. It does not seem

optimistic that they are going to help w/ the braces. Did you have

any luck w/ that? My surgery has not been submitted yet, so I don't

know what kind of problems I will have with that, but we can stay in

touch and learn from each other.

I am also on the same time crunch. My husband is going on a remote

in May, so we are looking at leaving here next May or June. I almost

hope to go overseas, where this would all be done by the military.

We are currently at Seymour in NC, so we are Tricare North.

I didn't think this made a difference, but I know people that have

had a hard time getting approved for other surgeries in one area, but

then it was a breeze in another region. Let me know what kind of

progress you make.

Rene`

> Hi All,

>

> I am a 38 year old woman facing orthognathic surgery - again. Let

me

> explain. Five years ago I started ortho treatment on my upper and

> lower jaws. After 2 years in braces, the ortho and the oral

surgeon

> both thought that the problem had been corrected orthodontically

and

> that I was not going to need surgery. So, after all of the

fighting

> and appeals to the insurance company to have the procedure approved

> (which it finally was), I never went through with the surgery (at

the

> surgeon's recommendation!).

>

> So, guess what? Here I am 3 years later, back in another ortho's

> office (we moved - we are military) being told that all of the

> treatment has regressed and I am needing surgery - sooner better

than

> later.

>

> I am so frustrated. Like I said, we are military and having the

> initial ortho and surgery approved was such a long, difficult,

drawn-

> out process. I am dreading having to go through that again - I

think

> I dread that even more than I am dreading having braces put back

on.

> People here aren't too optimistic that we will even be able to get

a

> second approval since I did not go through with the surgery the

first

> time.

>

> Is anyone else here working through TriCare? I would love any

advice

> that I can get on how to re-work this whole approval process. Like

I

> said, I have already visited the ortho and I have a referral to an

> oral surg for a consultation - I have to call him first thing in

the

> AM to see if I can get in to his office quickly to get this ball

> rolling.

>

> We are kind of working on a time-crunch. We are slated to move

again

> next summer and I would like to have as much of this done as

possible

> before we go. My ortho said he thought we could get through the

> surgery and partially into the post-op before I have to move, but

we

> would have to start in the next couple of weeks.

>

> Sorry about the long post - I appreciate your patience. I really

am

> a very happy person normally, but this is weighing heavily on me

> tonight.

>

> Cindy

[Guest guest]

My name is Amy. My husband is active duty. We're station at

MacDill AFB in Florida. I tried for years to get Tricare to approve

my surgery. I need it for functional reasons. I have migraines and

difficulty chewing. I was turned down three times by Tricare

because I was told it was a " cosmetic " procedure. I was so

frustrated and in terrible pain. After arriving at MacDill I

decided to try again. I found a wonderful oral surgeon here who

recognized my need to have this surgery. He was able to help me

work with Tricare to get it approved. We did have to pay for my

braces, but it's worth it. After 5 years of trying, I'm finally

having my surgery on September 28. I know it can be so frustrating,

but just keep trying. What helped me was finding the right surgeon

who was able to work the system and get it approved. I hope all

goes well for you.

> > Hi All,

> >

> > I am a 38 year old woman facing orthognathic surgery - again.

Let

> me

> > explain. Five years ago I started ortho treatment on my upper

and

> > lower jaws. After 2 years in braces, the ortho and the oral

> surgeon

> > both thought that the problem had been corrected orthodontically

> and

> > that I was not going to need surgery. So, after all of the

> fighting

> > and appeals to the insurance company to have the procedure

approved

> > (which it finally was), I never went through with the surgery

(at

> the

> > surgeon's recommendation!).

> >

> > So, guess what? Here I am 3 years later, back in another

ortho's

> > office (we moved - we are military) being told that all of the

> > treatment has regressed and I am needing surgery - sooner better

> than

> > later.

> >

> > I am so frustrated. Like I said, we are military and having the

> > initial ortho and surgery approved was such a long, difficult,

> drawn-

> > out process. I am dreading having to go through that again - I

> think

> > I dread that even more than I am dreading having braces put back

> on.

> > People here aren't too optimistic that we will even be able to

get

> a

> > second approval since I did not go through with the surgery the

> first

> > time.

> >

> > Is anyone else here working through TriCare? I would love any

> advice

> > that I can get on how to re-work this whole approval process.

Like

> I

> > said, I have already visited the ortho and I have a referral to

an

> > oral surg for a consultation - I have to call him first thing in

> the

> > AM to see if I can get in to his office quickly to get this ball

> > rolling.

> >

> > We are kind of working on a time-crunch. We are slated to move

> again

> > next summer and I would like to have as much of this done as

> possible

> > before we go. My ortho said he thought we could get through the

> > surgery and partially into the post-op before I have to move,

but

> we

> > would have to start in the next couple of weeks.

> >

> > Sorry about the long post - I appreciate your patience. I

really

> am

> > a very happy person normally, but this is weighing heavily on me

> > tonight.

> >

> > Cindy

[Guest guest]

I agree, but this worries me. My surgeons office says that they have

only done 4 or 5 w/ Tricare, but that they had went through without

any problems. It seems to easy, and I am so afraid that something

will go wrong. Tricare has declined my braces. I have a supplement

and was really hoping they would pay something, anything. My

supplement picks up 100% on anything that Tricare pays on. Oh well.

I wonder if anyone out there has gotten Tricare to pay for braces.

How long were you in braces prior to surgery.

Rene`

> > > Hi All,

> > >

> > > I am a 38 year old woman facing orthognathic surgery - again.

> Let

> > me

> > > explain. Five years ago I started ortho treatment on my upper

> and

> > > lower jaws. After 2 years in braces, the ortho and the oral

> > surgeon

> > > both thought that the problem had been corrected

orthodontically

> > and

> > > that I was not going to need surgery. So, after all of the

> > fighting

> > > and appeals to the insurance company to have the procedure

> approved

> > > (which it finally was), I never went through with the surgery

> (at

> > the

> > > surgeon's recommendation!).

> > >

> > > So, guess what? Here I am 3 years later, back in another

> ortho's

> > > office (we moved - we are military) being told that all of the

> > > treatment has regressed and I am needing surgery - sooner

better

> > than

> > > later.

> > >

> > > I am so frustrated. Like I said, we are military and having

the

> > > initial ortho and surgery approved was such a long, difficult,

> > drawn-

> > > out process. I am dreading having to go through that again - I

> > think

> > > I dread that even more than I am dreading having braces put

back

> > on.

> > > People here aren't too optimistic that we will even be able to

> get

> > a

> > > second approval since I did not go through with the surgery the

> > first

> > > time.

> > >

> > > Is anyone else here working through TriCare? I would love any

> > advice

> > > that I can get on how to re-work this whole approval process.

> Like

> > I

> > > said, I have already visited the ortho and I have a referral to

> an

> > > oral surg for a consultation - I have to call him first thing

in

> > the

> > > AM to see if I can get in to his office quickly to get this

ball

> > > rolling.

> > >

> > > We are kind of working on a time-crunch. We are slated to move

> > again

> > > next summer and I would like to have as much of this done as

> > possible

> > > before we go. My ortho said he thought we could get through

the

> > > surgery and partially into the post-op before I have to move,

> but

> > we

> > > would have to start in the next couple of weeks.

> > >

> > > Sorry about the long post - I appreciate your patience. I

> really

> > am

> > > a very happy person normally, but this is weighing heavily on

me

> > > tonight.

> > >

> > > Cindy

[Guest guest]

Last time I went through this I got TriCare to pay for my braces

100%. Yes, I did say 100%. Apparently this is unheard of, but we

did it. It did take several appeals and congressional contacts, but

we were finally able to convince them that the braces were an

integral part of the surgery - you can't do the surgery without

them. It doesn't make any sense to cover the surgery without the

braces.

I am really hoping things go well with approvals this time. I really

want to get the majority of this done here, but that means we need to

start pronto.

> > > > Hi All,

> > > >

> > > > I am a 38 year old woman facing orthognathic surgery -

again.

> > Let

> > > me

> > > > explain. Five years ago I started ortho treatment on my

upper

> > and

> > > > lower jaws. After 2 years in braces, the ortho and the oral

> > > surgeon

> > > > both thought that the problem had been corrected

> orthodontically

> > > and

> > > > that I was not going to need surgery. So, after all of the

> > > fighting

> > > > and appeals to the insurance company to have the procedure

> > approved

> > > > (which it finally was), I never went through with the surgery

> > (at

> > > the

> > > > surgeon's recommendation!).

> > > >

> > > > So, guess what? Here I am 3 years later, back in another

> > ortho's

> > > > office (we moved - we are military) being told that all of

the

> > > > treatment has regressed and I am needing surgery - sooner

> better

> > > than

> > > > later.

> > > >

> > > > I am so frustrated. Like I said, we are military and having

> the

> > > > initial ortho and surgery approved was such a long,

difficult,

> > > drawn-

> > > > out process. I am dreading having to go through that again -

I

> > > think

> > > > I dread that even more than I am dreading having braces put

> back

> > > on.

> > > > People here aren't too optimistic that we will even be able

to

> > get

> > > a

> > > > second approval since I did not go through with the surgery

the

> > > first

> > > > time.

> > > >

> > > > Is anyone else here working through TriCare? I would love

any

> > > advice

> > > > that I can get on how to re-work this whole approval

process.

> > Like

> > > I

> > > > said, I have already visited the ortho and I have a referral

to

> > an

> > > > oral surg for a consultation - I have to call him first thing

> in

> > > the

> > > > AM to see if I can get in to his office quickly to get this

> ball

> > > > rolling.

> > > >

> > > > We are kind of working on a time-crunch. We are slated to

move

> > > again

> > > > next summer and I would like to have as much of this done as

> > > possible

> > > > before we go. My ortho said he thought we could get through

> the

> > > > surgery and partially into the post-op before I have to move,

> > but

> > > we

> > > > would have to start in the next couple of weeks.

> > > >

> > > > Sorry about the long post - I appreciate your patience. I

> > really

> > > am

> > > > a very happy person normally, but this is weighing heavily on

> me

> > > > tonight.

> > > >

> > > > Cindy

[Guest guest]

Congrats for getting TriCare to pay for the braces! We didn't even

try to appeal because we knew (or thought we knew!) they wouldn't

cover mine anyway. Getting approval for the surgery itself was

easy. However, I just got the bill for the surgery - out of the

surgeon's almost $17,000 fee, TriCare allowed ONLY $2400, which is

absolutely ridiculous. No supplement here so it's time to empty the

pockets!

> > > > > Hi All,

> > > > >

> > > > > I am a 38 year old woman facing orthognathic surgery -

> again.

> > > Let

> > > > me

> > > > > explain. Five years ago I started ortho treatment on my

> upper

> > > and

> > > > > lower jaws. After 2 years in braces, the ortho and the

oral

> > > > surgeon

> > > > > both thought that the problem had been corrected

> > orthodontically

> > > > and

> > > > > that I was not going to need surgery. So, after all of

the

> > > > fighting

> > > > > and appeals to the insurance company to have the procedure

> > > approved

> > > > > (which it finally was), I never went through with the

surgery

> > > (at

> > > > the

> > > > > surgeon's recommendation!).

> > > > >

> > > > > So, guess what? Here I am 3 years later, back in another

> > > ortho's

> > > > > office (we moved - we are military) being told that all of

> the

> > > > > treatment has regressed and I am needing surgery - sooner

> > better

> > > > than

> > > > > later.

> > > > >

> > > > > I am so frustrated. Like I said, we are military and

having

> > the

> > > > > initial ortho and surgery approved was such a long,

> difficult,

> > > > drawn-

> > > > > out process. I am dreading having to go through that

again -

> I

> > > > think

> > > > > I dread that even more than I am dreading having braces

put

> > back

> > > > on.

> > > > > People here aren't too optimistic that we will even be

able

> to

> > > get

> > > > a

> > > > > second approval since I did not go through with the

surgery

> the

> > > > first

> > > > > time.

> > > > >

> > > > > Is anyone else here working through TriCare? I would love

> any

> > > > advice

> > > > > that I can get on how to re-work this whole approval

> process.

> > > Like

> > > > I

> > > > > said, I have already visited the ortho and I have a

referral

> to

> > > an

> > > > > oral surg for a consultation - I have to call him first

thing

> > in

> > > > the

> > > > > AM to see if I can get in to his office quickly to get

this

> > ball

> > > > > rolling.

> > > > >

> > > > > We are kind of working on a time-crunch. We are slated to

> move

> > > > again

> > > > > next summer and I would like to have as much of this done

as

> > > > possible

> > > > > before we go. My ortho said he thought we could get

through

> > the

> > > > > surgery and partially into the post-op before I have to

move,

> > > but

> > > > we

> > > > > would have to start in the next couple of weeks.

> > > > >

> > > > > Sorry about the long post - I appreciate your patience. I

> > > really

> > > > am

> > > > > a very happy person normally, but this is weighing heavily

on

> > me

> > > > > tonight.

> > > > >

> > > > > Cindy

[Guest guest]

Hmmm....I never really thought about this - trying to get your health insurance

to pay for braces. I am thinking now that I should file a claim, since the

surgery is impossible without first having braces on. I have BCBS, so we'll see

what happens...

flowersinthedirt wrote:

Congrats for getting TriCare to pay for the braces! We didn't even

try to appeal because we knew (or thought we knew!) they wouldn't

cover mine anyway. Getting approval for the surgery itself was

easy. However, I just got the bill for the surgery - out of the

surgeon's almost $17,000 fee, TriCare allowed ONLY $2400, which is

absolutely ridiculous. No supplement here so it's time to empty the

pockets!

> > > > > Hi All,

> > > > >

> > > > > I am a 38 year old woman facing orthognathic surgery -

> again.

> > > Let

> > > > me

> > > > > explain. Five years ago I started ortho treatment on my

> upper

> > > and

> > > > > lower jaws. After 2 years in braces, the ortho and the

oral

> > > > surgeon

> > > > > both thought that the problem had been corrected

> > orthodontically

> > > > and

> > > > > that I was not going to need surgery. So, after all of

the

> > > > fighting

> > > > > and appeals to the insurance company to have the procedure

> > > approved

> > > > > (which it finally was), I never went through with the

surgery

> > > (at

> > > > the

> > > > > surgeon's recommendation!).

> > > > >

> > > > > So, guess what? Here I am 3 years later, back in another

> > > ortho's

> > > > > office (we moved - we are military) being told that all of

> the

> > > > > treatment has regressed and I am needing surgery - sooner

> > better

> > > > than

> > > > > later.

> > > > >

> > > > > I am so frustrated. Like I said, we are military and

having

> > the

> > > > > initial ortho and surgery approved was such a long,

> difficult,

> > > > drawn-

> > > > > out process. I am dreading having to go through that

again -

> I

> > > > think

> > > > > I dread that even more than I am dreading having braces

put

> > back

> > > > on.

> > > > > People here aren't too optimistic that we will even be

able

> to

> > > get

> > > > a

> > > > > second approval since I did not go through with the

surgery

> the

> > > > first

> > > > > time.

> > > > >

> > > > > Is anyone else here working through TriCare? I would love

> any

> > > > advice

> > > > > that I can get on how to re-work this whole approval

> process.

> > > Like

> > > > I

> > > > > said, I have already visited the ortho and I have a

referral

> to

> > > an

> > > > > oral surg for a consultation - I have to call him first

thing

> > in

> > > > the

> > > > > AM to see if I can get in to his office quickly to get

this

> > ball

> > > > > rolling.

> > > > >

> > > > > We are kind of working on a time-crunch. We are slated to

> move

> > > > again

> > > > > next summer and I would like to have as much of this done

as

> > > > possible

> > > > > before we go. My ortho said he thought we could get

through

> > the

> > > > > surgery and partially into the post-op before I have to

move,

> > > but

> > > > we

> > > > > would have to start in the next couple of weeks.

> > > > >

> > > > > Sorry about the long post - I appreciate your patience. I

> > > really

> > > > am

> > > > > a very happy person normally, but this is weighing heavily

on

> > me

> > > > > tonight.

> > > > >

> > > > > Cindy

[Guest guest]

That was my point. The braces aren't optional. Tell me how you did

this. What kind of explainations did you have to provide?

Rene`

> > > > > Hi All,

> > > > >

> > > > > I am a 38 year old woman facing orthognathic surgery -

> again.

> > > Let

> > > > me

> > > > > explain. Five years ago I started ortho treatment on my

> upper

> > > and

> > > > > lower jaws. After 2 years in braces, the ortho and the

oral

> > > > surgeon

> > > > > both thought that the problem had been corrected

> > orthodontically

> > > > and

> > > > > that I was not going to need surgery. So, after all of the

> > > > fighting

> > > > > and appeals to the insurance company to have the procedure

> > > approved

> > > > > (which it finally was), I never went through with the

surgery

> > > (at

> > > > the

> > > > > surgeon's recommendation!).

> > > > >

> > > > > So, guess what? Here I am 3 years later, back in another

> > > ortho's

> > > > > office (we moved - we are military) being told that all of

> the

> > > > > treatment has regressed and I am needing surgery - sooner

> > better

> > > > than

> > > > > later.

> > > > >

> > > > > I am so frustrated. Like I said, we are military and

having

> > the

> > > > > initial ortho and surgery approved was such a long,

> difficult,

> > > > drawn-

> > > > > out process. I am dreading having to go through that

again -

> I

> > > > think

> > > > > I dread that even more than I am dreading having braces put

> > back

> > > > on.

> > > > > People here aren't too optimistic that we will even be able

> to

> > > get

> > > > a

> > > > > second approval since I did not go through with the surgery

> the

> > > > first

> > > > > time.

> > > > >

> > > > > Is anyone else here working through TriCare? I would love

> any

> > > > advice

> > > > > that I can get on how to re-work this whole approval

> process.

> > > Like

> > > > I

> > > > > said, I have already visited the ortho and I have a

referral

> to

> > > an

> > > > > oral surg for a consultation - I have to call him first

thing

> > in

> > > > the

> > > > > AM to see if I can get in to his office quickly to get this

> > ball

> > > > > rolling.

> > > > >

> > > > > We are kind of working on a time-crunch. We are slated to

> move

> > > > again

> > > > > next summer and I would like to have as much of this done

as

> > > > possible

> > > > > before we go. My ortho said he thought we could get

through

> > the

> > > > > surgery and partially into the post-op before I have to

move,

> > > but

> > > > we

> > > > > would have to start in the next couple of weeks.

> > > > >

> > > > > Sorry about the long post - I appreciate your patience. I

> > > really

> > > > am

> > > > > a very happy person normally, but this is weighing heavily

on

> > me

> > > > > tonight.

> > > > >

> > > > > Cindy

[Guest guest]

I am wondering if Tricare denied because my OS said that this was for

the tx of TMJ in his notes. That is only one of my problems. I will

try appealing the decision, but I am going to go ahead and proceed in

the mean time. I don't want to put this off any longer than

necessary. Time is essential here.

Rene`

> > > > > > Hi All,

> > > > > >

> > > > > > I am a 38 year old woman facing orthognathic surgery -

> > again.

> > > > Let

> > > > > me

> > > > > > explain. Five years ago I started ortho treatment on my

> > upper

> > > > and

> > > > > > lower jaws. After 2 years in braces, the ortho and the

> oral

> > > > > surgeon

> > > > > > both thought that the problem had been corrected

> > > orthodontically

> > > > > and

> > > > > > that I was not going to need surgery. So, after all of

> the

> > > > > fighting

> > > > > > and appeals to the insurance company to have the

procedure

> > > > approved

> > > > > > (which it finally was), I never went through with the

> surgery

> > > > (at

> > > > > the

> > > > > > surgeon's recommendation!).

> > > > > >

> > > > > > So, guess what? Here I am 3 years later, back in another

> > > > ortho's

> > > > > > office (we moved - we are military) being told that all

of

> > the

> > > > > > treatment has regressed and I am needing surgery - sooner

> > > better

> > > > > than

> > > > > > later.

> > > > > >

> > > > > > I am so frustrated. Like I said, we are military and

> having

> > > the

> > > > > > initial ortho and surgery approved was such a long,

> > difficult,

> > > > > drawn-

> > > > > > out process. I am dreading having to go through that

> again -

> > I

> > > > > think

> > > > > > I dread that even more than I am dreading having braces

> put

> > > back

> > > > > on.

> > > > > > People here aren't too optimistic that we will even be

> able

> > to

> > > > get

> > > > > a

> > > > > > second approval since I did not go through with the

> surgery

> > the

> > > > > first

> > > > > > time.

> > > > > >

> > > > > > Is anyone else here working through TriCare? I would

love

> > any

> > > > > advice

> > > > > > that I can get on how to re-work this whole approval

> > process.

> > > > Like

> > > > > I

> > > > > > said, I have already visited the ortho and I have a

> referral

> > to

> > > > an

> > > > > > oral surg for a consultation - I have to call him first

> thing

> > > in

> > > > > the

> > > > > > AM to see if I can get in to his office quickly to get

> this

> > > ball

> > > > > > rolling.

> > > > > >

> > > > > > We are kind of working on a time-crunch. We are slated

to

> > move

> > > > > again

> > > > > > next summer and I would like to have as much of this done

> as

> > > > > possible

> > > > > > before we go. My ortho said he thought we could get

> through

> > > the

> > > > > > surgery and partially into the post-op before I have to

> move,

> > > > but

> > > > > we

> > > > > > would have to start in the next couple of weeks.

> > > > > >

> > > > > > Sorry about the long post - I appreciate your patience.

I

> > > > really

> > > > > am

> > > > > > a very happy person normally, but this is weighing

heavily

> on

> > > me

> > > > > > tonight.

> > > > > >

> > > > > > Cindy

[Guest guest]

Give it a try, but BCBS in this area will not cover the ortho w/ the

surgery. It's in the handbook. I can get BCBS free from my work,

but they conflict w/ Tricare so much it was a constant hassle so I

dropped them. The insurance person at my OS office said that they

were more difficult to get the surgery approved through too. I

figured I would just get the Tricare supplement. It seems like they

differ state to state and maybe you will have some luck. I thought

it was terrible that I was more insured than some and had a harder

time getting anything paid.

Rene

> > > > > > Hi All,

> > > > > >

> > > > > > I am a 38 year old woman facing orthognathic surgery -

> > again.

> > > > Let

> > > > > me

> > > > > > explain. Five years ago I started ortho treatment on my

> > upper

> > > > and

> > > > > > lower jaws. After 2 years in braces, the ortho and the

> oral

> > > > > surgeon

> > > > > > both thought that the problem had been corrected

> > > orthodontically

> > > > > and

> > > > > > that I was not going to need surgery. So, after all of

> the

> > > > > fighting

> > > > > > and appeals to the insurance company to have the

procedure

> > > > approved

> > > > > > (which it finally was), I never went through with the

> surgery

> > > > (at

> > > > > the

> > > > > > surgeon's recommendation!).

> > > > > >

> > > > > > So, guess what? Here I am 3 years later, back in another

> > > > ortho's

> > > > > > office (we moved - we are military) being told that all

of

> > the

> > > > > > treatment has regressed and I am needing surgery - sooner

> > > better

> > > > > than

> > > > > > later.

> > > > > >

> > > > > > I am so frustrated. Like I said, we are military and

> having

> > > the

> > > > > > initial ortho and surgery approved was such a long,

> > difficult,

> > > > > drawn-

> > > > > > out process. I am dreading having to go through that

> again -

> > I

> > > > > think

> > > > > > I dread that even more than I am dreading having braces

> put

> > > back

> > > > > on.

> > > > > > People here aren't too optimistic that we will even be

> able

> > to

> > > > get

> > > > > a

> > > > > > second approval since I did not go through with the

> surgery

> > the

> > > > > first

> > > > > > time.

> > > > > >

> > > > > > Is anyone else here working through TriCare? I would

love

> > any

> > > > > advice

> > > > > > that I can get on how to re-work this whole approval

> > process.

> > > > Like

> > > > > I

> > > > > > said, I have already visited the ortho and I have a

> referral

> > to

> > > > an

> > > > > > oral surg for a consultation - I have to call him first

> thing

> > > in

> > > > > the

> > > > > > AM to see if I can get in to his office quickly to get

> this

> > > ball

> > > > > > rolling.

> > > > > >

> > > > > > We are kind of working on a time-crunch. We are slated

to

> > move

> > > > > again

> > > > > > next summer and I would like to have as much of this done

> as

> > > > > possible

> > > > > > before we go. My ortho said he thought we could get

> through

> > > the

> > > > > > surgery and partially into the post-op before I have to

> move,

> > > > but

> > > > > we

> > > > > > would have to start in the next couple of weeks.

> > > > > >

> > > > > > Sorry about the long post - I appreciate your patience.

I

> > > > really

> > > > > am

> > > > > > a very happy person normally, but this is weighing

heavily

> on

> > > me

> > > > > > tonight.

> > > > > >

> > > > > > Cindy

>

>

>

>

>

>

[Guest guest]

Hi there Rene,

In my Tricare handbook (I'm in MD) it specifically says any

orthodontics, including those used in conjunction with any medical

or cosmetic procedure, will not be covered. That is why I didn't

even try to get insurance to cover my braces.

As for why things are approved or not approved, you're right it does

have a lot to do with what the surgeon writes. I'm wondering why

mine was only approved for a fraction of what the surgery was

worth. I'm looking into any appealing options I may have...

> > > > > > > Hi All,

> > > > > > >

> > > > > > > I am a 38 year old woman facing orthognathic surgery -

> > > again.

> > > > > Let

> > > > > > me

> > > > > > > explain. Five years ago I started ortho treatment on

my

> > > upper

> > > > > and

> > > > > > > lower jaws. After 2 years in braces, the ortho and

the

> > oral

> > > > > > surgeon

> > > > > > > both thought that the problem had been corrected

> > > > orthodontically

> > > > > > and

> > > > > > > that I was not going to need surgery. So, after all

of

> > the

> > > > > > fighting

> > > > > > > and appeals to the insurance company to have the

> procedure

> > > > > approved

> > > > > > > (which it finally was), I never went through with the

> > surgery

> > > > > (at

> > > > > > the

> > > > > > > surgeon's recommendation!).

> > > > > > >

> > > > > > > So, guess what? Here I am 3 years later, back in

another

> > > > > ortho's

> > > > > > > office (we moved - we are military) being told that

all

> of

> > > the

> > > > > > > treatment has regressed and I am needing surgery -

sooner

> > > > better

> > > > > > than

> > > > > > > later.

> > > > > > >

> > > > > > > I am so frustrated. Like I said, we are military and

> > having

> > > > the

> > > > > > > initial ortho and surgery approved was such a long,

> > > difficult,

> > > > > > drawn-

> > > > > > > out process. I am dreading having to go through that

> > again -

> > > I

> > > > > > think

> > > > > > > I dread that even more than I am dreading having

braces

> > put

> > > > back

> > > > > > on.

> > > > > > > People here aren't too optimistic that we will even be

> > able

> > > to

> > > > > get

> > > > > > a

> > > > > > > second approval since I did not go through with the

> > surgery

> > > the

> > > > > > first

> > > > > > > time.

> > > > > > >

> > > > > > > Is anyone else here working through TriCare? I would

> love

> > > any

> > > > > > advice

> > > > > > > that I can get on how to re-work this whole approval

> > > process.

> > > > > Like

> > > > > > I

> > > > > > > said, I have already visited the ortho and I have a

> > referral

> > > to

> > > > > an

> > > > > > > oral surg for a consultation - I have to call him

first

> > thing

> > > > in

> > > > > > the

> > > > > > > AM to see if I can get in to his office quickly to get

> > this

> > > > ball

> > > > > > > rolling.

> > > > > > >

> > > > > > > We are kind of working on a time-crunch. We are

slated

> to

> > > move

> > > > > > again

> > > > > > > next summer and I would like to have as much of this

done

> > as

> > > > > > possible

> > > > > > > before we go. My ortho said he thought we could get

> > through

> > > > the

> > > > > > > surgery and partially into the post-op before I have

to

> > move,

> > > > > but

> > > > > > we

> > > > > > > would have to start in the next couple of weeks.

> > > > > > >

> > > > > > > Sorry about the long post - I appreciate your

patience.

> I

> > > > > really

> > > > > > am

> > > > > > > a very happy person normally, but this is weighing

> heavily

> > on

> > > > me

> > > > > > > tonight.

> > > > > > >

> > > > > > > Cindy

[Guest guest]

Hi Samara,

I have been thinking the same thing. My insurance will not pay for

adult orthodontics, except in the case of an accident where teeth or

the jaws are broken. Since there ARE instances when it is already

covered, and my OD is integral to the jaw surgery, I have always

thought it should be a covered item when it is exclusively required

for the surgery. I mean, I would not have been a candidate for OD

simply due to my teeth. They were fine. It was the jaw problem

that required the braces and only as part and parcel of (integral

to) the jaw surgery.

I have a self funded insurance program through DH's work. There is

more room to have exceptions made and revise policy with a self

funded plan. Having already been part of a successful attempt to

expand a policy with this plan (for a problem completely unrelated

to jaw surgery), I know it takes a lot of letters, professional

support and letters/phone calls, and a clear case - that is not a

traditional case - that is reviewed and fits neatly into the policy

exclusions. The good part is that when you get it changed, it sets

precident which means more people, even with more marginal cases,ill

be able to appeal and win their cases.

The trick will be getting your OD and OS to do the necessary letter-

writing and phone-calling. They have to fight so often (and it is

time consuming) just for cases that are OBVIOUSLY included in a

policy already. I have already approached my OD and OS and they

seem reluctant to get on board with it. The OD, because I have

already signed a personal agreement with him to privately pay, and

that means he does not have to write letters or rock the boat, and

the OS because he is covered in our plan already. There is no real

benefit to them to do all the legwork, simply for a few people in

our plan to benefit somewhere down the road.

I am still going to try, but be prepared if you are going to do this

also, that it will mean you have to initiate each letter and what is

included in the letter. Not what is included that is professionally

related, but what information is relevant to your policy. That

means some legwork on your part. Like finding out that they do pay

for OD sometimes in certain situations (like mine does for broken

teeth and jaws in an accident). And then get your OD to write that

it is not for a bite abnormality, but a jaw abnormality etc etc

etc. It will take some time and effort, but it can be done. The

fact that you have a precident you can cite from this board will

also help you. That is actually a fantastic fact to have in your

corner. Once precident it set, it has greased the wheel for those

down the road.

Good luck with this. I will let you know if I get anwywhere, and

will watch for your posts about your situation.

Hugs,

Fran

I wish you good luck with this. The fact that yours are

> > > > > > Hi All,

> > > > > >

> > > > > > I am a 38 year old woman facing orthognathic surgery -

> > again.

> > > > Let

> > > > > me

> > > > > > explain. Five years ago I started ortho treatment on my

> > upper

> > > > and

> > > > > > lower jaws. After 2 years in braces, the ortho and the

> oral

> > > > > surgeon

> > > > > > both thought that the problem had been corrected

> > > orthodontically

> > > > > and

> > > > > > that I was not going to need surgery. So, after all of

> the

> > > > > fighting

> > > > > > and appeals to the insurance company to have the

procedure

> > > > approved

> > > > > > (which it finally was), I never went through with the

> surgery

> > > > (at

> > > > > the

> > > > > > surgeon's recommendation!).

> > > > > >

> > > > > > So, guess what? Here I am 3 years later, back in

another

> > > > ortho's

> > > > > > office (we moved - we are military) being told that all

of

> > the

> > > > > > treatment has regressed and I am needing surgery -

sooner

> > > better

> > > > > than

> > > > > > later.

> > > > > >

> > > > > > I am so frustrated. Like I said, we are military and

> having

> > > the

> > > > > > initial ortho and surgery approved was such a long,

> > difficult,

> > > > > drawn-

> > > > > > out process. I am dreading having to go through that

> again -

> > I

> > > > > think

> > > > > > I dread that even more than I am dreading having braces

> put

> > > back

> > > > > on.

> > > > > > People here aren't too optimistic that we will even be

> able

> > to

> > > > get

> > > > > a

> > > > > > second approval since I did not go through with the

> surgery

> > the

> > > > > first

> > > > > > time.

> > > > > >

> > > > > > Is anyone else here working through TriCare? I would

love

> > any

> > > > > advice

> > > > > > that I can get on how to re-work this whole approval

> > process.

> > > > Like

> > > > > I

> > > > > > said, I have already visited the ortho and I have a

> referral

> > to

> > > > an

> > > > > > oral surg for a consultation - I have to call him first

> thing

> > > in

> > > > > the

> > > > > > AM to see if I can get in to his office quickly to get

> this

> > > ball

> > > > > > rolling.

> > > > > >

> > > > > > We are kind of working on a time-crunch. We are slated

to

> > move

> > > > > again

> > > > > > next summer and I would like to have as much of this

done

> as

> > > > > possible

> > > > > > before we go. My ortho said he thought we could get

> through

> > > the

> > > > > > surgery and partially into the post-op before I have to

> move,

> > > > but

> > > > > we

> > > > > > would have to start in the next couple of weeks.

> > > > > >

> > > > > > Sorry about the long post - I appreciate your patience.

I

> > > > really

> > > > > am

> > > > > > a very happy person normally, but this is weighing

heavily

> on

> > > me

> > > > > > tonight.

> > > > > >

> > > > > > Cindy

>

>

>

>

>

>

[Guest guest]

Was the surgeon in your network? I get so frustrated with all of

this insurance stuff. I hope my supplement pays like it is supposed

to. I've never used it before.

Rene

> > > > > > > > Hi All,

> > > > > > > >

> > > > > > > > I am a 38 year old woman facing orthognathic surgery -

> > > > again.

> > > > > > Let

> > > > > > > me

> > > > > > > > explain. Five years ago I started ortho treatment on

> my

> > > > upper

> > > > > > and

> > > > > > > > lower jaws. After 2 years in braces, the ortho and

> the

> > > oral

> > > > > > > surgeon

> > > > > > > > both thought that the problem had been corrected

> > > > > orthodontically

> > > > > > > and

> > > > > > > > that I was not going to need surgery. So, after all

> of

> > > the

> > > > > > > fighting

> > > > > > > > and appeals to the insurance company to have the

> > procedure

> > > > > > approved

> > > > > > > > (which it finally was), I never went through with the

> > > surgery

> > > > > > (at

> > > > > > > the

> > > > > > > > surgeon's recommendation!).

> > > > > > > >

> > > > > > > > So, guess what? Here I am 3 years later, back in

> another

> > > > > > ortho's

> > > > > > > > office (we moved - we are military) being told that

> all

> > of

> > > > the

> > > > > > > > treatment has regressed and I am needing surgery -

> sooner

> > > > > better

> > > > > > > than

> > > > > > > > later.

> > > > > > > >

> > > > > > > > I am so frustrated. Like I said, we are military and

> > > having

> > > > > the

> > > > > > > > initial ortho and surgery approved was such a long,

> > > > difficult,

> > > > > > > drawn-

> > > > > > > > out process. I am dreading having to go through that

> > > again -

> > > > I

> > > > > > > think

> > > > > > > > I dread that even more than I am dreading having

> braces

> > > put

> > > > > back

> > > > > > > on.

> > > > > > > > People here aren't too optimistic that we will even

be

> > > able

> > > > to

> > > > > > get

> > > > > > > a

> > > > > > > > second approval since I did not go through with the

> > > surgery

> > > > the

> > > > > > > first

> > > > > > > > time.

> > > > > > > >

> > > > > > > > Is anyone else here working through TriCare? I would

> > love

> > > > any

> > > > > > > advice

> > > > > > > > that I can get on how to re-work this whole approval

> > > > process.

> > > > > > Like

> > > > > > > I

> > > > > > > > said, I have already visited the ortho and I have a

> > > referral

> > > > to

> > > > > > an

> > > > > > > > oral surg for a consultation - I have to call him

> first

> > > thing

> > > > > in

> > > > > > > the

> > > > > > > > AM to see if I can get in to his office quickly to

get

> > > this

> > > > > ball

> > > > > > > > rolling.

> > > > > > > >

> > > > > > > > We are kind of working on a time-crunch. We are

> slated

> > to

> > > > move

> > > > > > > again

> > > > > > > > next summer and I would like to have as much of this

> done

> > > as

> > > > > > > possible

> > > > > > > > before we go. My ortho said he thought we could get

> > > through

> > > > > the

> > > > > > > > surgery and partially into the post-op before I have

> to

> > > move,

> > > > > > but

> > > > > > > we

> > > > > > > > would have to start in the next couple of weeks.

> > > > > > > >

> > > > > > > > Sorry about the long post - I appreciate your

> patience.

> > I

> > > > > > really

> > > > > > > am

> > > > > > > > a very happy person normally, but this is weighing

> > heavily

> > > on

> > > > > me

> > > > > > > > tonight.

> > > > > > > >

> > > > > > > > Cindy