Discouraging Consultation

[boatsink]

Hey there.

I recommend what almost50 says. Try a different surgeon within Kaiser. If approved, your life (financial aspect) would be so much easier. There are reputable surgeons with Kaiser (and plenty outside, but you will have to pay a lot!).

I went to see an OS 2 weeks ago with Kaiser and was approved right on the spot. His assistant took my study models and xrays on her way out, while having me watch a 10 minute orthognathic surgery video. When the surgeon came in he just said, "I agree that orthodontia alone will not fix your problem". Approval just like that. I don't have any problems w/ opening my mouth or pain associated chewing. He barely assessed me physically, but I assume the study model and xrays was good enough.

[LAJaw]

boatsink, glad to hear you got approval already. I'm going in for my consult in two weeks. Who did you up with as your OS?

[boatsink]

Hey LaJaw, thanks - it was a nerve-wracking experience in all - didn't know what to expect and if I would be approved.

I'm from the bay area. I was referred to Dr. Bui; he will be my primary surgeon and assisting surgeon is Dr. Desai.

Goodluck!

[margan]

Thanks for the careful advice; this forum is more helpful than I expected.
I didn't have study models or xrays. I had just been referred by my primary physician. The surgeon asked me to open my mouth and move my jaw side to side. So, do I request another referral from my primary doctor or wait to see orthodontist first? I have an appointment with a UCLA doctor today and a referral from my dentist to I think a good ortho who from his web page also does surgery. But absolutely, considering expenses, I'll try to get more help from Kaiser.

[dvdrdiscs]

boatsink,

What insurance carrier do you use?

[Noam]

I met with maxiofacial doc at Kaiser today who said that surgery is only performed on people who can barely open their mouths

LOL!

Does he also think that a nose job is only for people who can barely breath through their nose ???

For many people, Orthognathic surgery is an aesthetic surgery, just like a nose job. Insurance companies know it, and hence it's hard for many people to get coverage.

[margan]

The orthodontist I saw this morning at UCLA said he could do nothing to help me until the tmj issue is resolved. He actually said, contrary to Kaiser doc that I can't open my mouth completely. And unlike Kaiser doc, he said that relationship between bite and tmj is controversial--kaiser doc rejected it. I have overbite, overjet about which he said perhaps to be kind, that he's seen worse.

He referred me to Dr. Merrill at Orafacial Pain and Medicine. So I walked over through our wonderful LA storm to make an appointment. The consultation is a few hundered dollars and the joint xrays are another couple hundred. The consultation includes psychological testing!

Is this something I should be pursuing? I don't want to be given another prescription for muscle relaxors. But at least they would xray my jaw which Kaiser wouldn't do.

Feeling frustrated. Any advice? Thanks

[Noam]

The orthodontist I saw this morning at UCLA said he could do nothing to help me until the tmj issue is resolved. He actually said, contrary to Kaiser doc that I can't open my mouth completely. And unlike Kaiser doc, he said that relationship between bite and tmj is controversial--kaiser doc rejected it. I have overbite, overjet about which he said perhaps to be kind, that he's seen worse.

He referred me to Dr. Merrill at Orafacial Pain and Medicine. So I walked over through our wonderful LA storm to make an appointment. The consultation is a few hundered dollars and the joint xrays are another couple hundred. The consultation includes psychological testing!

Is this something I should be pursuing? I don't want to be given another prescription for muscle relaxors. But at least they would xray my jaw which Kaiser wouldn't do.

Feeling frustrated. Any advice? Thanks

Margan,

You don't need to have a functional problem with your mouth in order to have this surgery. This surgery can be done to correct functional problems, cosmetic problems, or both.

I'm doing this surgery purely from cosmetic reasons. Several yeast ago I went to an orthodontist in order to just straighten my teeth. The orthodontist told me that together with straighting my teeth, he thinks if I will correct my small underbite with surgery I will look better. I never had any functional problems with my bite and he never even asked, he talked purely from a cosmetic point to view.

I later went to see my surgeon. She measured my face and took a look at my bite. She told me I can open my mouth much more than what's considered to be normal. She told me that in her eyes my underbite is borderline, and she thinks I look good. She told me that it's up to me to decide if I want the surgery, she said "if it bothers you enough when you look at the mirror, go for it".

The thing is, if you're doing it just from cosmetics, you have less to gain from someone who also have functional problems.

[boatsink]

--> dvdrdiscs: I'm with Kaiser HMO. Specific plan ID I'm not sure, I'm just with my company. The copays aren't that great though - went up to $30 per PCP/specialist visit!

--> Margan: If braces cannot alone fix your bite, definitely see an OS. Study models and X-rays will definitely help you present your case. A good OS should be able to assess your mouth/bite and determine its appropriateness (without them, but not as accurate IMO). I'm not too sure how severe your overbite is. My sister had an underbite and was able to correct it with braces alone. Initially it was thought she may need orthognathic surgery as well. Perhaps your case is like that too? I'm sorry you are having to jump through all these hoops! It's time consuming, expensive and puts a physical and emotional stress on you. Yikes, and to deal with this storm! Hope it goes away soon! The weather up in the NorCal isn't that great right now either. What insurance are you with, Kaiser I assume?

"I had just been referred by my primary physician. The surgeon asked me to open my mouth and move my jaw side to side. So, do I request another referral from my primary doctor or wait to see orthodontist first?"

My ortho actually wrote my request for referral letter to see the oral surgeon to my PCP. It clearly wrote out what my bite/asymmetry problem was. To further support it, I had my study model and x-rays. Perhaps, you should investigate orthodontists to get a general consensus as to what your needs are and have them support you when seeing the oral surgeon again (if needed).. just a thought.

--> Noam:

"This surgery can be done to correct functional problems, cosmetic problems, or both. "

True indeed, but be careful with what you present to the surgeon/health insurances. I was cautioned by the Kaiser surgeon to be careful and not to mention it as a cosmetic procedure; otherwise they will not approve of it.

[boatsink]

Forgot to mention, I don't know much about TMJ issues and how it can support the need for the surgery, so you will definitely need someone else to chime in. I do have popping, clicking on my right side and occasional jaw locking; however, my OS said orthognathic surgery is not used to correct this issue. He was talking about discs and joints etc., but I blurred out at that point as I was happy to have been approved.

[ColoradoGirl]

I wonder if the TMJ/bite relationship changes depending on the patient? I have an underbite with pretty bad condylar reabsorption/arthritis; my doc says the surgery will definitely fix the TMJ issue in my case (stop the damage and reseat the joint, not actually repair the joint iteslf, which he says is rarely successful). I imagine that's something that's easiest to tell with X-Rays. Good luck, and stay dry (crazy California rain! It's nuts here too).

[LAJaw]

Margan, I also have Kaiser in LA and have my first consult with an OS in a few weeks. When they called me to set up my appointment, I was explicitly told I needed to bring a full set of photographs, X-rays, and models for the OS to even see me. I think you will probably have a better chance of approval if you bring to the OS more evidence demonstrating your need for surgery.

[dvdrdiscs]

--> dvdrdiscs: I'm with Kaiser HMO. Specific plan ID I'm not sure, I'm just with my company. The copays aren't that great though - went up to $30 per PCP/specialist visit!

--> Margan: If braces cannot alone fix your bite, definitely see an OS. Study models and X-rays will definitely help you present your case. A good OS should be able to assess your mouth/bite and determine its appropriateness (without them, but not as accurate IMO). I'm not too sure how severe your overbite is. My sister had an underbite and was able to correct it with braces alone. Initially it was thought she may need orthognathic surgery as well. Perhaps your case is like that too? I'm sorry you are having to jump through all these hoops! It's time consuming, expensive and puts a physical and emotional stress on you. Yikes, and to deal with this storm! Hope it goes away soon! The weather up in the NorCal isn't that great right now either. What insurance are you with, Kaiser I assume?

"I had just been referred by my primary physician. The surgeon asked me to open my mouth and move my jaw side to side. So, do I request another referral from my primary doctor or wait to see orthodontist first?"

My ortho actually wrote my request for referral letter to see the oral surgeon to my PCP. It clearly wrote out what my bite/asymmetry problem was. To further support it, I had my study model and x-rays. Perhaps, you should investigate orthodontists to get a general consensus as to what your needs are and have them support you when seeing the oral surgeon again (if needed).. just a thought.

--> Noam:

"This surgery can be done to correct functional problems, cosmetic problems, or both. "

True indeed, but be careful with what you present to the surgeon/health insurances. I was cautioned by the Kaiser surgeon to be careful and not to mention it as a cosmetic procedure; otherwise they will not approve of it.

That's good to know. I also have Kaiser HMO. My group plan is actually very good. I pay zip out of pocket for anything except $5 for prescription drugs.

Magan, maybe you are approaching this from the wrong angle. Unless I'm reading it wrong, and I apologize if I am, you should find an orthodontist first? A good orthodontist can probably help convince your oral surgeon more effectively, especially if your orthodontist has a specific surgeon he/she uses.