Guest guest Posted August 19, 2005 Report Share Posted August 19, 2005 Sorry to hear about your woes on insurance. When I first seeked approval, it was with United health care, and they pre-approved my Surgery. But by the time I was approching Surgery, my company had swithed Health Care Providers, and the next one would not approve. Then they switched to Blue Cross, Blue Shield and they approved. But many say it is the luck of the draw. Some get approved and some don't for reasons unknown. Keep trying! Jim Strack > Hi all > My pre-surgery experience is turning into the biggest nightmare ever! My > surgery has been indefinitely cancelled until my orthodontist can get > thespace between 2 of my teeth on the side, which he's been trying since > May; and I just found out yesterday that my insurance denied my claim, > saying that they saw it as purely cosmetic, and of no " medical necessity " . I > have been to several orthodontists and surgeons before I made this decision, > and not one of them has told me that this would be entirely cosmetic, and > all have said that it would be helping me breathe, eat, w/ TMJ problems, > etc. I have United Healthcare insurance, and does anyone know if it is > common for insurance to deny these types of surgeries upfront? And what are > my chances with an appeal? My surgeon has already written a letter, but said > he could write another one, but not sure if that would help too much. Anyone > been through this? > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 20, 2005 Report Share Posted August 20, 2005 Clare- I had the same problem with United Health Care and my OS did the appeal and they denied it again. I said a few choice words to them in my mind. I have changed jobs and now have Blue Cross Blue Shield and have been denied but we are working on a appeal as we speak - cross your fingers it works! But, none the less, I am starting to set aside some money in case it doesn't cover it for the medical financial aid. Also, I thought about taking out a home equity loan if the rate is lower. Good luck to you! Clare Creelman wrote: Hi all My pre-surgery experience is turning into the biggest nightmare ever! My surgery has been indefinitely cancelled until my orthodontist can get thespace between 2 of my teeth on the side, which he's been trying since May; and I just found out yesterday that my insurance denied my claim, saying that they saw it as purely cosmetic, and of no " medical necessity " . I have been to several orthodontists and surgeons before I made this decision, and not one of them has told me that this would be entirely cosmetic, and all have said that it would be helping me breathe, eat, w/ TMJ problems, etc. I have United Healthcare insurance, and does anyone know if it is common for insurance to deny these types of surgeries upfront? And what are my chances with an appeal? My surgeon has already written a letter, but said he could write another one, but not sure if that would help too much. Anyone been through this? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 22, 2005 Report Share Posted August 22, 2005 Hi Clare, I also have United Healthcare. They denied my claim twice. The second claim was from a different doctor and they sent the reply to the first doctor. What that said to me was that they didn't even look at the claim, just denied it (think Grisham movie/book). So, I work for a small company and we outsource our HR stuff, so I contacted the company that handles our insurance and had them make some calls. My policy covers TMJ surgery, but doesn't distinguish orthognathic as part of that. The person in charge of my company's insurance policies contacted United and told them that it needed to be re-evaluated and kept stating that the surgery was NOT cosmetic, that it was to help with TMJ symptoms. Next thing I know, I get a letter saying the surgery has been approved. Make sure to have someone who is in your HR dept or handles insurance for your company call. When I called, I got a really rude person who was of no help at all. Usually HR people have other routes they can take. Another friend has had numerous surgeries, one of them being orthognathic (due to a birth defect) and he swears that calling the CEO of United (or in his case, Blue Cross Blue Shield) is the way to get things approved. I hope everything works out. > Hi all > My pre-surgery experience is turning into the biggest nightmare ever! My > surgery has been indefinitely cancelled until my orthodontist can get > thespace between 2 of my teeth on the side, which he's been trying since > May; and I just found out yesterday that my insurance denied my claim, > saying that they saw it as purely cosmetic, and of no " medical necessity " . I > have been to several orthodontists and surgeons before I made this decision, > and not one of them has told me that this would be entirely cosmetic, and > all have said that it would be helping me breathe, eat, w/ TMJ problems, > etc. I have United Healthcare insurance, and does anyone know if it is > common for insurance to deny these types of surgeries upfront? And what are > my chances with an appeal? My surgeon has already written a letter, but said > he could write another one, but not sure if that would help too much. Anyone > been through this? > > > Quote Link to comment Share on other sites More sharing options...
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