Anyone having surgery without insurance coverage?

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#1 Post by **HeatherLynn** » Sat Aug 26, 2006 11:10 am

I had made up my mind to go through with surgery when I found out my insurance did not cover it. There was a chance that our insurance was going to change and the surgery would be covered. It did not change and Health Assurance WILL NOT cover it. I'm so upset now. I hate to keep putting it off year after year in the hopes of the insurance change. But I believe the surgeon said the lower jaw advancement would be around $20,000 not including the hospital stay. I'm thinking of getting another surgeon's quote. I have three girls...two who have started orthodontics and cannot afford that kind of a bill right now. Thanks for listening!!!

#2 Post by **anabel** » Sat Aug 26, 2006 12:14 pm

A) That sounds like a lot for just one jaw and B) Initially (and many many times thereafter) my insurance people said there was no way they'd pay for my surgery (upper, lower, genio), that they never do, no matter how bad the sleep apnea, headaches, gum recession, etc. are. So the plan was for me to get on my husband's insurance and they were going to cover most of it. I found out a few days ago that at the time of my surgery the first insurance was still considered my primary, so my OS's office submitted the bill to it, expecting them to deny, at which point they would submit to my secondary (my husband's). Lo and behold, I got my first statement from my primary insurance and THEY ARE COVERING MOST OF IT. Point is, you never know.

#3 Post by **Julie08** » Sat Aug 26, 2006 7:10 pm

I sympathize - I was also told my insurance will most likely not cover it - and to expect to pay up to 30,000 USD for lower jaw advancement (hopefully no upper jaw surgery will be needed) ---- if there are complications, of course I will be liable for payment of those costs also. Ortho said majority of costs are the hospital and he will help negotiate lower fees, sometimes that will knock a few thousand off. But any way you go, it's a lot to come up with out of your own pocket. I feel like I need to do it -- saving my teeth just doesn't seem optional to me. I understand your plight.

#4 Post by **HeatherLynn** » Sun Aug 27, 2006 6:16 pm

The OS office submitted the info. to my insurance and was told they will not cover it. No matter what. I thought the $20,000 was high too after reading other posts. I may go to another surgeon and see what their costs would be. I could handle $10,000. I would do it in a minute. Some people think I should wait. Maybe our insurance will change next year. But then again it may not. It is difficult when you finally make a major decision like this and are ready to got through with it only to find out you might not be able to. I saw Phil's post about writing to the OS. Might conisder doing that.

#5 Post by **KJNELLAMORE** » Mon Aug 28, 2006 11:16 am

Heather- do you mind if I ask who your insurance carrier is?

#6 Post by **HeatherLynn** » Mon Aug 28, 2006 11:33 am

Sure, it is Health Assurance. I called them today and told them our policy was renewed and I was wondering if there are any instances where orthognathic surgery is covered. Now this girl told me to have the Dr. write a detailed description of my problem and give it a try. I know the surgeon's person that deals with insurance submitted it, but not with a Dr.'s note. I've been told there is no way at all it will be covered, but I'm trying it again. I think I will visit another surgeon and see what they say. I have a 9mm overbite and cannot close my lips together. That causes me to sleep with my mouth open. I also have headaches often. I have never formally been diagnosed with TMJ. I have to make sure the surgeon did not list that as the problem or I think I'm done.

#7 Post by **nvcarissa** » Mon Aug 28, 2006 11:58 am

My OS' fee was less than $5K, the assistant surgeon was 1/4 of that. The hospital bill, on the other hand, (2 night stay, operating room) was over $22K (completely covered by insurance). For your OS to say HIS fee without hospital would be $20K seems really high.

I had lower jaw advancement.

#8 Post by **HeatherLynn** » Mon Aug 28, 2006 12:05 pm

I know. I have a call into them to get the exact cost again. But as I said, I'm going to also visit another surgeon. This office is one of the top in the area I believe. They have worked on some of the Steelers. I felt very comfortable with the surgeon, but that is just out of the question for me.

Wed Aug 30, 2006 7:49 pm

hey Hunnn I jsut got that same surgury on aug 25th and it only costed me $2,500.00 that is crazy 20,000$ I think that your doctor is trying to take you for a ride and a half. where abouts are u living. I am on vancouver island, BC (canada)
umm it would actaully cost you less to fly here have it done and go back home.
Seriously. and it is not covered under medical here either. but the doctor that i had was super nice and all that jazz!!!

umm I hope that you can figure it out if you need any more info becasue i know a few of the surgans . just give me a shout!!
Hope it goes well!
_brittany

#10 Post by **HeatherLynn** » Wed Aug 30, 2006 8:17 pm

I'm waiting to hear back from the OS to make sure they were correct in that amount. I can't believe it either. Maybe she messed up (I HOPE!). If this OS will not contact he insurance with a written letter, I will see someone else. Right now I'm just waiting for everyone else to get back to me.

I have 8 teeth missing because my earlier ortho felt that necessary. Boy is all of this info. coming in handy for dealing with my girls and their ortho! NO TEETH PULLED! AND there are devices used to correct the lower jaw deficiency and bring the lower jaw forward while you are growing. I see this problem in my second daughter and will be sure to address this with her ortho. I have been to four different orthos who have been very nice, but one stands out in their treatmentment for me and options for my girls. You really need to get many opinions (lesson learned!) Thanks for all of the advice!

#11 Post by **phil** » Thu Aug 31, 2006 4:44 am

Hey, HeatherLynn!

I had to jump in, since Meryaten used my name in vain (just kidding).

In my opinion, $20,000 sounds too high. I will have double (mandibular and maxillary) surgery next summer, and my surgeon's fees for that come to about $12,500. When I found out that my insurance company would not pay ANYTHING, I wrote a letter to my surgeon, asking for a fee reduction--I figured that any reduction would be better than none, so I was prepared to be grateful. Lo and behold, he agreed to reduce fees by a generous 30%. They also work with the hospital to set up a prepaid option for people who are having surgical procedures not covered by insurance (mostly cosmetic surgery--I hate being lumped in with that category!).

Insurance companies can be a pain. In the case of mine (AETNA), they specifically say that orthognathic surgery is NOT covered, so I figured that I couldn't fight City Hall. We did a pre-approval and everything, too.

I might suggest that you get another opinion/quote from another surgeon on fees, although the bottom line is that you have to trust the person that you're working with, and have confidence that he/she can do the job well. Good luck!

#12 Post by **HeatherLynn** » Thu Aug 31, 2006 9:19 am

Wow Phil, I thought that your insurance was one that covered the surgery! What was your hospital bill? And what is a prepaid option?

The office called back today and the billing lady said "Oh, it will be thousands of dollars" when I asked the cost without insurance. She could not give me an answer and will call back. Maybe she was guessing before? Who knows. In the meantime while I'm waiting, I will be calling my dentist for a rferral to another OS.

I did find out that Health Assurance, no way no how will cover this. Unless maybe you fell on your face off of a bridge I was told. This billing person even saw people try to take them to the insurance (whatever it is...a legal board) only to be turned down. It is because it is plain as day in black and white that they do not cover and there are no loopholes.

#13 Post by **ohmyjaw** » Thu Aug 31, 2006 11:59 am

Hi everyone!

Just wanted to jump in becuase first of all, I am in the same vicinity as Brittany! (Vancouver Island) Who is your surgeon Brittany?? I read your other post - how is it going with the no eating? I am even lighter than you (5'5" and 105 pounds) and I will have my jaw wired shut. My surgery is sometime in January, probably.

My surgery will be about $7000 Canadian, and that is for upper and lower lower at the same time. Glad I am getting it all over with at once, I guess. I have NO insurance WHATSOEVER, but in Canada apparently surgery is just cheaper, or they don't require anyone to ever pay the full cost.

Kim - just wanted to say I really hope you figure out the insurance stuff. Even though my treatment isn't finished yet, it has had a real impact on my life and how I feel about myself, and I know its worth every penny. If I had to pay $20,000 or more I would still do it; it would just take me longer (yeah, a lot longer!)

I have a narrow pallatte, maybe not quite as narrow as yours though, and I am having my upper jaw expanded at the same time as they will correct my underbite AND correct the asymmetry of my lower jaw.... They are going to take a piece of bone from my leg and put it in my upper palatte to make it wider. Sounds a bit crazy, huh? Has anyone else out there had this????

HeatherLynn - I hope you get your insurance stuff figured out too - good luck with everything. Good for you for not letting your daughters have teeth pulled. I had teeth pulled as a kid and I now need at least one implant, at great expense. Lessons learned INDEED.

Well that was a bit rambling! Bye for now.

#14 Post by **phil** » Thu Aug 31, 2006 1:32 pm

Hey, HeatherLynn!

Here's what I'm paying for everything:

Ortho: $6300 (minus $1000 insurance coverage [Delta Dental]
Surgical Palatal Expansion: $1900 (plus $2300 in hospital/anesthesia fees)
BSSO, LeFort I: $8680 (plus estimated $7000 in hospital/anestesia fees)

So, all in all, this comes to a whopping sum of about $25,000 to have this all done. Needless to say, I've been saving my pennies.

A friend of mine, when he found out what my out-of-pocket was for all this treatment, he said, "well, I guess we know you really want this!" The only thing I've ever spent more money on in my life is a house, and I don't have that quite payed off!

The hospital where my surgeon practices has a special rate for services associated with elective surgery (mostly cosmetic). It's not quite as expensive as what they would charge otherwise--kind of a package deal. It's a smaller hospital, but I was quite pleased with most of my care during the previous surgery.

I hope you find this information helpful.

#15 Post by **HeatherLynn** » Wed Sep 27, 2006 10:32 am

Just found out the totals and I was SICK!

$882 (must be paid 2 weeks in advance)
$17,873 Hospital Stay
$7,000 for actual surgery (which was $10,000 but they are giving me a discount since the insurance will not cover it.

YIKES! If I get one of the Blue Cross/Blue Shield insurances (I'm pretty sure they cover the surgery)...It would cost me around $400 a month. One year waiting for pre-existing condition (not sure what determines that...it is not on my primary care record and my insurance says they do not have record of anything being submitted.) I'm wondering if I should get my own insurance and then drop it after the surgery.

I have an appointment with the OS on Monday to discuss the problems I could have if I do not go forward with the surgery. My dentist said I have a collapsing bite that could eventually cause permanent nerve damage or my jaw could start locking up.

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