Who was you Doctor?
What hospital?
Did insurance cover your procedure?
If not, how much did it cost you?
Any having or have had surgery in Dallas?
Moderator: bbsadmin
Re: Any having or have had surgery in Dallas?
I did not have the surgery but went through all the motions only to find out I had chronic Lyme disease and was advised by my Lyme doc to postpone the surgery so I could treat the Lyme first.
I saw Dr. W in Dallas, though, and spent 2 months on the phone between his office and my insurance company. I have 2 medical insurances of which one is Medicare due to a medical disability. Dr. W's office assistant told me they do not accept assignment from any medical plan and would not file anything with Medicare so I was going to have to be my own advocate to make things happen. They will not call your insurance company but they will be happy to tell you what your cash amount is up front, payable before surgery is scheduled.
This was a few years ago but I remember having to get an upper MRI at Baylor where Dr. W does the surgery. I have been told he does 2 surgeries a week. Dr. W is an expert at what he does and so he charges for what he feels he's worth. Keep in mind he has spent many years studying and perfecting his techniques and his education wasn't free. He does other film studies in his office and maps out the measurements of what your new face will look like as opposed to what it was before surgery. He and his surgical staff actually perform a mock surgery on a head-model before he attempts the actual surgery.
I felt confident, after meeting with him, that I wanted him as my surgeon. He was so precise, professional, and kind. I can't say enough good about him and I have heard some of his past patients tell how he changed their lives for the better and I met one of those, a young girl from California who had had several failed surgeries and learned of Dr. W and flew to DAL for 2 weeks for surgery and post-op followup. Wow, was she happy with her outcome.
Unfortunately, as in my case, hopefully not yours, though, I researched this forum and some legal forums about insurance companies so I could be my best defense but I failed miserably because my husband's employer is self-funded and the Texas Insurance Board does not interfere with their determinations. I tried the bit about their not having any other OS's within 100 miles of my home and they should pay per network deficiency but that fell on deaf ears. I'd make calls and get denials every few days. I even involved my husband's H/R person, the home office H/R person, and finally the insurance broker that will not a help in any way because the employers pay the broker to secures an insurance companies and sets dollar amounts per applicable procedure codes.
What a shock when Dr. W's office called at 8am one morning and said my surgery date was set and as soon as I paid the $38,000 I would be given a time slot and pre-op information. I quickly denied the invitation.
It is possible some of Dr. W's policies have changed since I saw him but not likely. I was given a couple other OS's in DAL that did the same surgery, TM replacement, and one of them was in network but wouldn't accept my secondary, Medicare. I will have to search for my file to find this doc's name but if you would like it please PM and I'll see if I can find it.
To make my insurance company happy and to comply with their requests I saw 2 other OS's, one in Longview, TX that did not perform TM replacements thus he referred me to Dr. W and the 2nd in Shreveport, LA that was a rude man who told me a long story how Dr. W suckers these people in to surgeries they don't need. I told him I had spent several hours with Dr. W and I never garnered that opinion of him. He was way too scary for me.
Be aware that your insurance company may throw you a list of OS's not qualified to do this surgery. Some of the ones I spoke with only did the surgery once or twice a year and one office told me the OS took a rib bone for part of the reconstruction.
I'm sure someone on this forum has had a good outcome with a surgeon other than Dr. W. Good Luck!
I saw Dr. W in Dallas, though, and spent 2 months on the phone between his office and my insurance company. I have 2 medical insurances of which one is Medicare due to a medical disability. Dr. W's office assistant told me they do not accept assignment from any medical plan and would not file anything with Medicare so I was going to have to be my own advocate to make things happen. They will not call your insurance company but they will be happy to tell you what your cash amount is up front, payable before surgery is scheduled.
This was a few years ago but I remember having to get an upper MRI at Baylor where Dr. W does the surgery. I have been told he does 2 surgeries a week. Dr. W is an expert at what he does and so he charges for what he feels he's worth. Keep in mind he has spent many years studying and perfecting his techniques and his education wasn't free. He does other film studies in his office and maps out the measurements of what your new face will look like as opposed to what it was before surgery. He and his surgical staff actually perform a mock surgery on a head-model before he attempts the actual surgery.
I felt confident, after meeting with him, that I wanted him as my surgeon. He was so precise, professional, and kind. I can't say enough good about him and I have heard some of his past patients tell how he changed their lives for the better and I met one of those, a young girl from California who had had several failed surgeries and learned of Dr. W and flew to DAL for 2 weeks for surgery and post-op followup. Wow, was she happy with her outcome.
Unfortunately, as in my case, hopefully not yours, though, I researched this forum and some legal forums about insurance companies so I could be my best defense but I failed miserably because my husband's employer is self-funded and the Texas Insurance Board does not interfere with their determinations. I tried the bit about their not having any other OS's within 100 miles of my home and they should pay per network deficiency but that fell on deaf ears. I'd make calls and get denials every few days. I even involved my husband's H/R person, the home office H/R person, and finally the insurance broker that will not a help in any way because the employers pay the broker to secures an insurance companies and sets dollar amounts per applicable procedure codes.
What a shock when Dr. W's office called at 8am one morning and said my surgery date was set and as soon as I paid the $38,000 I would be given a time slot and pre-op information. I quickly denied the invitation.
It is possible some of Dr. W's policies have changed since I saw him but not likely. I was given a couple other OS's in DAL that did the same surgery, TM replacement, and one of them was in network but wouldn't accept my secondary, Medicare. I will have to search for my file to find this doc's name but if you would like it please PM and I'll see if I can find it.
To make my insurance company happy and to comply with their requests I saw 2 other OS's, one in Longview, TX that did not perform TM replacements thus he referred me to Dr. W and the 2nd in Shreveport, LA that was a rude man who told me a long story how Dr. W suckers these people in to surgeries they don't need. I told him I had spent several hours with Dr. W and I never garnered that opinion of him. He was way too scary for me.
Be aware that your insurance company may throw you a list of OS's not qualified to do this surgery. Some of the ones I spoke with only did the surgery once or twice a year and one office told me the OS took a rib bone for part of the reconstruction.
I'm sure someone on this forum has had a good outcome with a surgeon other than Dr. W. Good Luck!
Re: Any having or have had surgery in Dallas?
Dr. Stephen Hill in Richardson - great surgeon
Medical City Dallas
My insurance covered it. I have BCBS for federal employees.
Medical City Dallas
My insurance covered it. I have BCBS for federal employees.
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Jsmith1972
- Posts: 14
- Joined: Fri Aug 19, 2011 8:13 pm
Re: Any having or have had surgery in Dallas?
I have BCBS also, but was denied. I spoke with our benefits director today and she said there was hope for an appeal if we can show that the braces will not correct my bite. Ha! My braces are making my bite worse because I have a 9 mm overjet!
Anyway, we're going to resubmit and pray a lot... Otherwise, I will be paying out of pocket.
When did you have the surgery?
Anyway, we're going to resubmit and pray a lot... Otherwise, I will be paying out of pocket.
When did you have the surgery?
Re: Any having or have had surgery in Dallas?
I had the surgery last November. You should check with Dr. Hill. BCBS would not give me a straight answer so Hill just submitted the precertification papers to BCBS with a surgery date two weeks away (we were still a year out from being ready). BCBS responded it would be covered. So since my insurance did not change any by the time we were ready for the surgery we knew they would cover it. I was only ought of pocket for the genio since they considered that cosmetic. You can check out the before and after at www.rodney008jawsurgery.shutterfly.com.
Best of luck.
Best of luck.
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Jsmith1972
- Posts: 14
- Joined: Fri Aug 19, 2011 8:13 pm
Re: Any having or have had surgery in Dallas?
Rodney,
Was your's BCBSTX PPO or HMO?
I am hopeful that we can get coverage. Our benefits director seems to think we have a good shot at it.
Was your's BCBSTX PPO or HMO?
I am hopeful that we can get coverage. Our benefits director seems to think we have a good shot at it.