Metal Mouth Message Board

Wondering what insurances archwired members are using to get reasonable coverage for ortho and orthognathic surgeries

I'm currently paying @$400/month for medical and dental. Since it's Kaiser it's an HMO and the dental only covers half my dental costs. I'm letting go of this real soon. Instead I'm shopping for a PPO that will cover some ortho, oral surgery and/or maxillofacial surgery costs as well.

I hear Aetna, Cigna and United Healthcare PPOs are decent. Have to admit, I'm worried that Cigna has gone cheap in the last couple years and not paying the docs much at all.

Would love to know what you're all using.

From what I know, no insurance will pay for the orthognatic surgery UNLESS you (or your doctor) can really prove that this is medically needed. You can look up a very good explanation of what is considered medically needed or what is not in the web, at least I have Aetna and their explanation was very comprehensive. Also, many insurances will specifically exclude TMJ as a medically valid factor, so beware of that as well.
In general, good luck with your search. I have several friends going on through orthognatic surgeries and their fights with insurance companies were unbelievable

I would research for your area the different companies because the amounts vary from each state.
I have delta and lifetime ortho coverage is $1,500.00 and regular dental coverage, I think, is $2000 a calendar year. Other folks who have delta have higher amounts than me...not sure why.

Are you paying on your own?
Can you do more than one company at a time?

I have Delta Dental of California (Delta PPO) through my work. My lifetime ortho is $2000 and my calendar year max for dental is $1500.

We have dental insurance through work but coverage is not good. It only covers 1 prophylaxis per year, 6 tooth fillings and 2 tooth extractions. Any ortho procedure is not covered. Thats the reason we got full coverage dental plans because our dental insurance is not good.