Re: Insurance company denial -i'm so confused

[Guest guest]

Hi Amy,

Have you gone through the appeal process after your pre-cert was

denied? I've read on this board, and also had the experience that

the first request is often denied and then approved the second time

through. My surgeon was asked for more in-depth records and a letter

stating that it was medically necessary, then the pre-cert company

approved it without a problem.

Try, try again.

Sue

>

> Well, after 2 years in braces waiting to get orthognathic surgery

(i forget all the technical

> terms but,) for lower jaw advancement, top jaw widening and

correcting vertical excess...the

> insurance company comes back and says they will only cover half the

surgery. The woman at

> my oral surgeon's office told me today that they will cover the

LeFort portion but not the

> sagittal split. Now, i thought (it's been a while since i've

thought about this in technical

> terms) that meant they were gonna cover my lower jaw advancement

but not the widening.

> After looking up what those terms meant on Google, it seems that

they will cover the upper

> jaw surgery but not the lower!! Can't they see that my bottom jaw

is a whole tooth width

> behind where it should be! I'm so confused and upset right now. I

was supposed to have this

> done in January. I'm 27 and i thought finally i would be happy with

my smile and my face. I

> just don't get it. I pay for my own insurance out of my own

pocket! The oral surgeon's office

> said that he would be in touch with me to see if we can 'get away'

with just doing the one

> surgery. But i don't want to just 'get away' with it. I want what

i've been waiting for for years!

> Another option would be to pay myself for the other half of the

procedure that's not

> approved. Does anyone have a ballpark estimate of how much that

would be? Or any

> experience with denials from insurance companies? Any help would be

great right now...i'm

> just so upset. i'm glad i can vent on here were people understand!

>

> thanx for letting me vent,

> amy

>