Hello-
I have Blue Cross/Blue Sheild in SC. They do not cover jaw surgery if it cosmetic but they do if it is documented as a medical necessity. In my case this was determined by the size of my open bite and number of teeth in functional contact. I'm so thankful it was covered, but like many others have expressed I likely would have paid for it myself as well. It may be worth it to look into BC/BS but make sure you know the coverage of your plan (what works in one state relative to coverage might not work with another plan). It's hard to believe there is so much variability in the coverage of such surgery. They covered upper/lower and genioplasty. I was told by the surgeon's office they wouldn't cover the genio so I felt like I got Christmas in July on that one. Good luck.
Anyone having surgery without insurance coverage?
Moderator: bbsadmin
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HeatherLynn
- Posts: 37
- Joined: Sun Apr 23, 2006 10:40 am
- Location: Butler, PA
Wow I can't believe the covered that! Well, my overbite is almost 10mm, so typically it should be covered. I have to talk to the OS and let this sink in. $30,000 when it is all said and done with the braces. (or a little more). That is a huge chunk of change! But I know deep down inside I have made my decision to go through with it. This is all if I can get financing through Capital One and have payments lower than $200 per month. I can't max myself out because my 11 year old is due to get braces and then my 9 year old will be next!
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hippyhippo
- Posts: 136
- Joined: Wed Jul 05, 2006 12:14 pm
- Location: Canada
I'm going to be having a BSSO in about a years time. What it's costing me:
Ortho Records: $525
Ortho Treatment: $6840 (this was discounted rate, b/c I paid all up front)
Initial Surgeon Consult: $250
Surgeon's Fees: $4500
Hospital Stay, etc: Free (thanks to universal health care)
Insurance is paying for:
Ortho Treatment & records: $2000
Initial Surgeon Consult: $125
So all in all, I'll be paying $10K ($9990 to be exact).
Ortho Records: $525
Ortho Treatment: $6840 (this was discounted rate, b/c I paid all up front)
Initial Surgeon Consult: $250
Surgeon's Fees: $4500
Hospital Stay, etc: Free (thanks to universal health care)
Insurance is paying for:
Ortho Treatment & records: $2000
Initial Surgeon Consult: $125
So all in all, I'll be paying $10K ($9990 to be exact).
wow!
Hello to everyone!
I too, unfortunately, am not covered by my insurance! I'm too old! My orthodontal braces alone is costing me $3,400. And my surgery is costing me $2,650 with Metlife paying a decent $882 of the surgery, because I also decided to get my wisdom tooth out, because it's impacted in my jaw. But TG they actually are paying for a big portion of the anesthesia, only because the wisdom tooth was included in the surgery. That makes it a total of about $1,200 total, for the surgery. So for the whole thing will be $4,600 US Dollars. Which for me, that's a lot of cash. TG for Capital One!
---Lillie32
I too, unfortunately, am not covered by my insurance! I'm too old! My orthodontal braces alone is costing me $3,400. And my surgery is costing me $2,650 with Metlife paying a decent $882 of the surgery, because I also decided to get my wisdom tooth out, because it's impacted in my jaw. But TG they actually are paying for a big portion of the anesthesia, only because the wisdom tooth was included in the surgery. That makes it a total of about $1,200 total, for the surgery. So for the whole thing will be $4,600 US Dollars. Which for me, that's a lot of cash. TG for Capital One!
---Lillie32
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HeatherLynn
- Posts: 37
- Joined: Sun Apr 23, 2006 10:40 am
- Location: Butler, PA
heatherlynn
Oh, sorry I didn't explain this well. Ok, the surgery cost included the IV sedation/anesthesia, the removal/extraction of the two baby teeth, exposure of the permanent canines, which were impacted, and extraction of only one wisdom tooth, which was the last one I still had left over in my mouth, and never came out, because it was impacted under the jaw bone. JFYI, I had the top wisdom teeth removed at about age oh, I think about 17, maybe. For some reason, the doc at that time, refused to remove this last one. The other side, the wisdom tooth erupted, because I had a molar removed at age 8 or 9, so there was actually enough room. Too bad though, cause it caused me to gain a crossbite in the long run. (That's another good reason for the braces.)
They did not pay for any surgery dealing with orthodontic treament. So the most expensive part of my surgery, which was the exposure, I have to pay myself. So $900 for both teeth, and then 20% of everything else, you know, including the IV sedation, removal of baby canines, and removal of impacted wisdom tooth (only the one). This puts me then at a total of about $1,200.
I think it's not fair for them not to cover adults over 19 yrs old. I have had Metlife for almost 10 years, always paying my premiums, and now that I really need them for something other then my regular cleanings, they're letting me down. I think they should make an exception for certain cases. You know, like if it's not solely cosmetic. But oh well, that's their rules. My friend's insurance covers her orthodontic treatment (she's also like my age, 35yo, I think), so I guess it's such a matter of picking the right plan and or insurance company.
---Lillie
They did not pay for any surgery dealing with orthodontic treament. So the most expensive part of my surgery, which was the exposure, I have to pay myself. So $900 for both teeth, and then 20% of everything else, you know, including the IV sedation, removal of baby canines, and removal of impacted wisdom tooth (only the one). This puts me then at a total of about $1,200.
I think it's not fair for them not to cover adults over 19 yrs old. I have had Metlife for almost 10 years, always paying my premiums, and now that I really need them for something other then my regular cleanings, they're letting me down. I think they should make an exception for certain cases. You know, like if it's not solely cosmetic. But oh well, that's their rules. My friend's insurance covers her orthodontic treatment (she's also like my age, 35yo, I think), so I guess it's such a matter of picking the right plan and or insurance company.
---Lillie
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HeatherLynn
- Posts: 37
- Joined: Sun Apr 23, 2006 10:40 am
- Location: Butler, PA
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HeatherLynn
- Posts: 37
- Joined: Sun Apr 23, 2006 10:40 am
- Location: Butler, PA
Irony of insurance not paying
I was talking to a friend about the fact that I will have to pay for my jaw surgery myself because my insurance will not cover it ( I guess keeping your teeth is considered "cosmetic.") She pointed out how ironic it is that I cannot get insurance to pay for something I am proactively and responsibly trying to take care of (saving my teeth) but I could get rip roaring drunk and get into a bar fight and get my jaw broken - and insurance would cover the surgery costs in full!
Yes, that's ironic! (don't worry - I have no intention of going this route!)
Yes, that's ironic! (don't worry - I have no intention of going this route!)
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karebear46168
- Posts: 100
- Joined: Tue Dec 05, 2006 10:12 am
- Location: IN
HeatherLynn,
what ever happened with this? I too have a 9mm over jet, with a lot of crowding on top. the ortho suggested I see an OS, but their fee for consult is 285.00 plus x-rays are extra for lower jaw surgery, I have Sagamore health insurance and the benefits book says it does not cover the surgery unless it's an accidental injury (?????? go figure). So I am very curious as to how this turned out.
Phil,
how old are you? (if you don't mind) I too have Delta Dental and was told that they did not cover any orhto for adults.
thanks!
I also have been told I need 6 teeth taken out (only two are wisdom)
what ever happened with this? I too have a 9mm over jet, with a lot of crowding on top. the ortho suggested I see an OS, but their fee for consult is 285.00 plus x-rays are extra for lower jaw surgery, I have Sagamore health insurance and the benefits book says it does not cover the surgery unless it's an accidental injury (?????? go figure). So I am very curious as to how this turned out.
Phil,
how old are you? (if you don't mind) I too have Delta Dental and was told that they did not cover any orhto for adults.
thanks!
I also have been told I need 6 teeth taken out (only two are wisdom)
My insurance covered about 98% of the total cost BUT the total cost was $232,000.00. That is not a typo. my parents nearly fell over when the bill came and thought that it couldn't possibly be right. It's not SO bad because the insurance did cover it but I only have a million dollar lifetime benefit which I just used over one fifth of 6 weeks ago. Now most likely I'll never have anything a tenth this expensive while I'm still under my parents insurance because I'll be out of college in a few years but we are trying to sort things out right now. Anyway I just thought I'd share that.
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HeatherLynn
- Posts: 37
- Joined: Sun Apr 23, 2006 10:40 am
- Location: Butler, PA
Hi karebear46168! Sorry I took so long to reply...we were out of town for a few days. I have been meaning to give an update.
It turns out that I was able to drop my husband's insurance and get my own (I have a small business out of my home and was able to get it under that). I will now carry BCBS. Tomorrow I will call in with the codes for the surgery to confirm they will cover it. The insurance broker I dealt with was 99% sure they would cover it. So now I have to find an ortho. and get moving! I cannot have any more teeth pulled because my old ortho already pulled out too many!
I had Health Assurance and this is one of the few insurances that it is written in stone that orthognathic surgery is not covered. I also was told unless you happen to fall off a bridge onto your face and break your jaw! That is nuts. But I would check into your insurance better. Sometimes the surgeon can write a note. I would ask the billing person at their office to guide you on that.
My dentist referred me to an OS and they just gave me options and prices. I did not have to pay anything or get X-Rays because they knew my insurance probably would not cover it. I was lucky in that way. Most of the other places would have charged for that.
GOOD LUCK!
It turns out that I was able to drop my husband's insurance and get my own (I have a small business out of my home and was able to get it under that). I will now carry BCBS. Tomorrow I will call in with the codes for the surgery to confirm they will cover it. The insurance broker I dealt with was 99% sure they would cover it. So now I have to find an ortho. and get moving! I cannot have any more teeth pulled because my old ortho already pulled out too many!
I had Health Assurance and this is one of the few insurances that it is written in stone that orthognathic surgery is not covered. I also was told unless you happen to fall off a bridge onto your face and break your jaw! That is nuts. But I would check into your insurance better. Sometimes the surgeon can write a note. I would ask the billing person at their office to guide you on that.
My dentist referred me to an OS and they just gave me options and prices. I did not have to pay anything or get X-Rays because they knew my insurance probably would not cover it. I was lucky in that way. Most of the other places would have charged for that.
GOOD LUCK!
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karebear46168
- Posts: 100
- Joined: Tue Dec 05, 2006 10:12 am
- Location: IN
thanks for the update, I'm so sorry that your old ortho pulled too many teeth, that would make me mad 
but what can you do now????
keep us updated! I'm still in the very beginnings of finding out all the ins and outs of the insurance coverage, I'm trying to get second opinions from my regular dentist, my periodontist, and my TMJ dentist, I want to make sure they all agree with the ortho's treatment plan! I don't want to rush into anything and then regret it later..........
good luck on your journey!
but what can you do now????keep us updated! I'm still in the very beginnings of finding out all the ins and outs of the insurance coverage, I'm trying to get second opinions from my regular dentist, my periodontist, and my TMJ dentist, I want to make sure they all agree with the ortho's treatment plan! I don't want to rush into anything and then regret it later..........
good luck on your journey!