Paying for Orthognathic Surgery

[DotNetShannon]

I've been in braces for the past 2 years and will need jaw surgery (top and bottom) some time this year. I've already had the consult with my oral surgeon, who has verified my health insurance policy has a specific exclusion for orthognathic surgery . Despite this, the cost of the surgery is $30k and right now my health insurance company wont cover any of it. I've contacted the benefits administrator at my company and mentioned this, she will be contacting the insurance company directly to see if there's anything they can do about it.

I'd like to try find a way to make this surgery a bit more affordable, but I'm at a dead-end right now. Has anyone had a similar experience? If you have any recommendations, I'd love to hear them.

[Emaciated]

There are a million threads on this forum from people asking the same question, try a search on "costs" or "insurance", etc. in this particular forum and number of related threads should be helpful.

One suggestion I can offer from experience is to look into a teaching hospital. I was being quoted $60K from local private surgeons in the Los Angeles area, but UCLA Dental School did the same thing for $12K. The funny thing is the guy who performed my surgery for $12K was the guy who trained a lot of the surgeons quoting me $60K.

[misiame]

I also took the medical tourism option. I am very happy with the whole experience. As a matter of fact I am still in Costa Rica and loving it!
Let me know if you want any more info. I know that at the begining people might think you are crazy for going to different country...but let me tell you they are wrong to think that. I am at a retreat with many other people from US. They came down here for many different surgeries. I have yet to hear a complain. I can honestly say that I have never in my life had had better medical care than down here. I am planning my next trip here for some dental work. I don't think I will ever go to a dentist in the States. The whole experience opened my eyes...

[jmrut22]

I called the hospital and told them my situation (insurance would not pay) they worked up a prepackaged deal for me for one nights stay. The surgery was billed at 30k, they charged me 10% and it was around 3050.00. Some hospitals do this for people who do not have insurance or for those like me who insurance would not pay. They essentially wrote off the rest of it. Made my day!! and saved me a ton of money. I'm in Tennessee.

[DotNetShannon]

There are a million threads on this forum from people asking the same question, try a search on "costs" or "insurance", etc. in this particular forum and number of related threads should be helpful.

One suggestion I can offer from experience is to look into a teaching hospital. I was being quoted $60K from local private surgeons in the Los Angeles area, but UCLA Dental School did the same thing for $12K. The funny thing is the guy who performed my surgery for $12K was the guy who trained a lot of the surgeons quoting me $60K.

Hi Karl,

Thanks for the info. Interesting idea... Did they perform the surgery in the hospital? I'm guessing the big discount here was on the survery itself, not necessarily the hospital fees? In my case, the surgery is 15k and hospital is another 15k.

I'll admit, I would be a bit weary about being a science project. How did you arrange this... by just calling up the dental school? Being that this was a teaching school, were there any guarantees or legality issues you were not covered on versus going to a regular surgeon?

Thanks again!

Shannon

[DotNetShannon]

Hi misiame,

I'd definitely be interested in hearing more about your story. How did the coordination work out between your orthodontist and oral surgeon? I heard I'd be out of work for about a month due to the surgery. I'm a bit curious if the surgeons over there provide any care for you after the surgery, as I probably wouldn't be able to have a friend/family member with me the whole time or at all. What kind of surgery did you have and how much did it cost? Also, how did you find the surgeon and coordinate everything? I imagine you had to take a couple trips to get your exam + surgery? So many questions, so little time .

Thanks!

Shannon

[DotNetShannon]

Hi jmrut22,

That's a steal! My hospital fees are 15k and surgery is 15k. There's another hospital in my area that may end up being cheaper, but wont give my oral surgeon a quote before the surgery. I tried to see if my oral surgeon would let me talk to the hospital directly, but they said they couldn't do that due to some policies. How were you able to negotiate a deal directly with the hospital?

Thanks!

Shannon

[misiame]

I am the second person, that i know of, from this forum who went to costa rica for jaw/s surgery. I had BSSO and an chin implant.
Thanks to the other person 4beauty4symmetry i found Dr. Oscar Raiche Fishel in San Jose.
go to www.costaricanewlook.com
the whole journey was coordinated by a wonderful person who works for my doctor. I paid for the surgery, 1 day at the hospital, 11 days at a beautiful retreat with meals 3x a day $8000.
I arrived on Sunday and I was picked up from the airport by a taxi sent by my retreat. The next day they took me to the hospital for blood work and many other diff tests. I passed them all and then I saw my OS.
You don't pay for the taxi at all it is included in tha price. I had my surgery the following day. I stayed overnight at the hospital and they took superb care of me. I was visited many times by my doctor.
At the reatreat they are well organized and if anything they always call your doctor and take you to see him. I am so happy I came here.
After you contact Dr. Raiche he will ask you to send him molds/xrays to costa rica. You don't have to fly here for consultation.
I feel extremely confident recomanding him to people. he is just the best!
Let me know if you need anything else. I am still in costa rica. I am going back home tomorrow.
Good luck and don't be afraid.

[DotNetShannon]

Thanks for the info. Just a few more questions . Is there any post-op checkup after the 11-days? Also, I'm currently in braces and understand the orthodontists/oral surgeons generally work together through this process. Being in a different country and all, do you know if this poses a problem? Hope you're enjoying Costa Rica!

[misiame]

The guys can always email /call eachother. From my experience here I have noticed very fast that the doctors here are more human...more caring. There was never rush. if I neede to see him i was in his office within a short time...
It is usually the case, no matter where the surgery was done, that the ortho takes over with aligning the teeth. I will have to see mine ortho in 2 weeks.
Every case is different...i am OK to return home and don't need to have more check ups.
If you decide I can give email of my wonderful C. who set up everything for me.
Good Luck ...

[jmrut22]

Well I didnt negotiate a deal. That is just the hospital policy. Like you I was in disbelif and questioned them and thier response was that most insurance plans in the state of Tn do not cover this surgery and this surgery is common so they set thier own policy over figureing the cost of this surgery for people in my situation.

This is also a teaching hospital so I dont know if that makes a difference or not but I imagine other states have similar plans.

[Emaciated]

Hi Karl,

Thanks for the info. Interesting idea... Did they perform the surgery in the hospital?

Yes, of course. It was performed at UCLA hospital (ranked 3rd best hospital in the US a huge banner in the lobby told me. No idea who #1 & #2 are.) The dental school is attached to (is part of) the hospital.

I'm guessing the big discount here was on the survery itself, not necessarily the hospital fees? In my case, the surgery is 15k and hospital is another 15k.

You know I couldn't tell you the hospital fees so you make a good point. I could look them up for you at home. But yes, you're right, the main price difference was the surgeon fees. My insurance covers hospital fees and anesthesia 100% so I didn't even pay attention to the costs. They only pay 90% of the surgeon fees so that is the cost that most concerned me.

I'll admit, I would be a bit weary about being a science project.

I was too until the day I met with the surgeon. He assured me that he performs the surgery, not some first-time student or what you imagine in your head. The only difference* between having the surgery at UCLA (a teaching hospital) and Cedars Sinai (a private hospital up the street in Beverly Hills) is that at UCLA there will be students present in the room. For example, one of my friends is an orthodontist student at UCLA and she was able to be in the surgery room with me for the entire procedure and, because I gave permission, was actually able to participate.

*This is of course ignoring the "recovery" factor, as recovery at Cedars Sinai is much much more pleasant than the UCLA hospital. But I was less concerned with recovery comfort than I was with having top notch surgery results for the best price.

How did you arrange this... by just calling up the dental school?

Yep. Exactly. Call your local university and get the names of the senior surgeon instructors then make an appointment with them. Obviously research the schools' reputation and the surgeon's reputation as well, but talking to them for a consultation is worth your time.

Being that this was a teaching school, were there any guarantees or legality issues you were not covered on versus going to a regular surgeon?

No. They were very thorough and very professional. I was well protected and well looked after. It was just like any other hospital.

You can read my whole experience on http://www.thisisjustwrong.com in the 'details' section if you want more info about the whole shabang. Check out "Perspective on Surgery" and "Notes from Recovery Room" to read about UCLA specifically. (Its a lot of reading, I apologize. I was recovering at home and had a lot of time to kill.)

[4beauty4symmetry]

Hello,


My ortho treatment was in t he US (round the corner from where I live, actually), while I had two surgeries with R in Costa Rica (see my signature for details.)

It went much easier than I thought, logisitically, tho it did provide some moments of anxiety for me.

Basically, I acted as informational gobetween the two men--the Ortho would pronounce me fit surgery, I would email R. directly and set up surgery dates.
One headscratching moment came when the Ortho said I was ready for the BSSO but the OMS said my bite would not be perfect post surgery. Turned out fine ine the end--just wore bands for several months following the BSSO to get the upper and lower aligned.

In regards to xrays, molds, etc--they were either emailed or smailmailed by the Ortho to the OMS.

R. is quite used to dealing with economic orthognatic refugess from the US i.e. he has done a fair number of BSSOs and LeForts and Sarpes on Americans who go to CR for these proceedures because they can't get insurance coverage. His spoken and written English is excellent. He trained at the University of Miami and University of Houston, and has a nice paper trail.

I didn't use a concierge or middleperson, btw, partly because I wanted to stay at a retreat closer to the city, and was very inflexible about my diet--low sodium, whole foods, mostly fruit and veggies.

A few days ago I went back and read some of my old posts from when I had the BSSO. Barely remembered much of what I wrote there-- was hilarious to read these daily detailed accounts of my meals -- like y'all were sitting on the edge of your chairs with bated breats waiting for the next entry--lol.

Anyway, good luck with all this.

[Julie08]

My insurance also excludes jaw surgery. I have been in braces almost two years. I was also quoted up to $30k for the surgery. My insurance turned me down, so I will be paying out of pocket. The surgeon said to help reduce the cost, if I live locally (near his practice) and someone can be there for me right after surgery and be with me the first few days, that I probably will not have to stay overnight in the hospital. Staying overnight shoots the bill up dramatically - up to $10k. I'm also in the in the mid-south area of the U.S. I'm mentioning this because that may be a way for others to save more $$$ if paying out of pocket (and if you are lucky enough not to experience any complications from the surgery.)

I am now waiting for a date to be scheduled for the surgery (it's been delayed, while we tried in vain to get insurance to cover it).

[NoCPAPPleez]

You all raise some very good points.

Personally I would LOVE to see before and after photos of you folks who had surgery in CR, and I'm sure I'm not alone in that!

Does the doc in CR do extensive pre-surgical planning, i.e. does he show you what you will look like afterward with software?

At this point the only potential downsides with having it done out of country are (1) Extended stay out of country (10 to 12 days is a long time to my mind) and (2) Post-op complications don't always show up in the immediate post-operative period.

Teaching hospitals are generally fine, but it should be noted that not every teaching hospital -- or even every state-university-affiliated hospital -- has a dental school. (University of Arizona doesn't have a dental school) In addition, some of the smaller dental schools don't offer orthognathic surgery. In my case, LA would be closest (400 miles), but when I called UCLA they couldn't tell me how many pre-operative visits I would need to make while in braces for surgical planning, etc.

I am seriously considering relocating to California, where at least state law will protect me from the "blanket exclusion" crapola I am dealing with now.