Amy/Re: Insurance company denial -i'm so confused

[Guest guest]

DEFINITELY appeal it. Insurance companies seems to always deny first, and then

once you

appeal, they actually pay attention.

Have your docs write a letter saying both surgeries are a medical necessity, and

use the

term " skeletal deformity " . That's what worked for me.

Get this: I wanted to have surgery a year ago, but was denied November 2004. I

fought for

6 months, appealed with a big stack of supporting evidence, and was finally

approved May

2005. Then, when I submitted the first bill from the surgeon's consultation

visit, they

denied me again, saying they didn't have enough evidence. Can you believe that?

I thought

the whole thing was hilarious, considering I had a letter dated from May 2005

saying they

originally approved it. They are idiots. I simply had my ortho take more xrays

and digital

photos, and I sent them in with the exact same packet of documents I sent the

first time,

which contained a letter from every specialist I had seen since 1999 saying the

same thing:

that this was a medical necessity to correct a skeletal deformity. By September

2005, they

sent me another letter saying they approved again, and I finally had the surgery

last week.

I also pay for insurance out of pocket ($400 to cover just myself, my poor

husband doesn't

even have any coverage at all, we can't afford it!), and it's only to cover this

surgery. Keep

fighting, it's worth it, you will win. They are trying to make you run around in

circles and

get tired of fighting and give up, but don't let them! Try to take step back

from the whole

scenario and be amused at how ridiculous they are being. Keep up the good fight!

You'll

get there, but you might have to wait. The waiting is truly the hardest part,

but it will be

over eventually, you'll see.

Jen

surgery date: 11/10/05

upper, lower, and genio

> >

> > 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

> >

>