Oral surgeon consult - and insurance question.

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parsleysage
Posts: 351
Joined: Tue Mar 18, 2014 10:42 am
Location: Virginia

Oral surgeon consult - and insurance question.

#1 Post by parsleysage »

(Posted in my braces story but wanted to put it here as well.)

Insurance covered my consult so I just paid $60 copay. They took my BP, look at the pics and x-rays I brought, and then the doc looked in my mouth and we had a 15-minute conversation.

I liked the surgeon, he was really nice. He was very soft-spoken. I am used to doctors being opinionated and, not "loud" exactly, just... authoritative. (Which they should be, since they are the authorities!) He said the same thing as all the other doctors. Lower jaw is "relatively" too large - it's actually normal size and my upper jaw too small. He recommended a 1-piece LeFort I. Insurance code D7946.

We talked about the alternatives to surgery and he asked if my ortho had talked about "camouflage" with me, meaning trying to disguise the malocclusion by moving only the teeth. I said that he did, and he said he could even try it out with just rubber bands, but that he didn't think it would work, and I didn't want the expense or frustration of still needing surgery anyway and having to reverse all the movement.

We also talked about sleep apnea. I'm not sure if I have it or not - I know I can't sleep on my back because right before I fall asleep I make an involuntary noise that wakes me up. I have chronic back and neck pain caused in part by stomach sleeping, so believe me when I say I have TRIED AND TRIED to learn to sleep on my back. I don't know if this is apnea or not. Depending on the insurance approval I may try to get tested for it. But even then, I am overweight, so I am sure if I was diagnosed insurance would say I should lose weight first to see if that helps before they would approve the surgery. (Which I would agree with, but just saying hypothetically, if it was declined based on my occlusion and related difficulties alone.)

Speaking of which, here's my insurance question. Obviously there is no substitute for actually getting the approval from the insco but just wanted anyone's opinion or experience. Aetna, my company, has a published policy for approving orthognathic surgery. Here it is: http://www.aetna.com/cpb/medical/data/1_99/0095.html They will approve it for any overjet 0 to negative value (mine is 0) if it is documented to cause masticatory dysfunction. My question is, does the wear and chipping on my front teeth count as dysfunction caused by my edge-to-edge? On my lateral incisors the chipping is pretty significant (10% of the teeth according to one of the orthos I saw) and will need to be bonded after I finish ortho. On my right front tooth there was a chip that my dentist fixed recently with composite. I also have superficial fracture lines on my front teeth (no known trauma). The first ortho I saw told me even if I didn't get braces I should get a night guard or my teeth would continue to wear down significantly. I'm hoping these things will have an impact on the surgery approval. Any insight?

Here's something that was weird... he said ONE WEEK of recovery!!! :shock: :shock: :shock: lol, I mean, I guess that's good news, but gosh, I thought I'd still be getting nose bleeds at 1 week. I would still be on a liquid diet at that point, with its associated weakness and lack of energy. I work 11-hour days in a call center. I'm not sure at all I'll be up for going back to work after 1 week. I asked him about going back so soon since I talk for a living and he said, "That may or may not affect your recovery, but you could maybe take a week and a half." :huh: Everything I've seen online says 3-6 weeks. I saw one girl on YouTube who went back to work at 2 weeks but couldn't make it through a single day and decided to take another week. We will cross that bridge when we come to it of course, but if I do take time off I will need the surgeon to sign short-term disability paperwork so I don't lose my salary during recovery.

All in all it was a good consult. They are going to submit the preapproval with the surgeon's letter and I should know in a few weeks. I told him the timeline I'm on for getting my braces on (about one month from now) and he said I should know by then.

samoorelaw
Posts: 441
Joined: Sun Jul 14, 2013 4:44 pm
Location: Las Vegas, Nevada

Re: Oral surgeon consult - and insurance question.

#2 Post by samoorelaw »

Hello,

I had a LeFort I, and I returned to work after 3 weeks. I'm a lawyer who talks for a living and I found talking to be exhausting, especially since I was banded shut for just shy of 6 weeks. Granted I think I could have returned to work after two weeks, but my energy level was ridiculously low so that wouldn't have been an option. I know of people who took just one week off but they returned to restricted duty. I say err on the side of caution and plan for a minimum of 2/3 weeks.

Wish I could answer the insurance question. I had an underbite so the determination of my surgery being medically necessary was a different analsyis that didn't involve an overjet: I have united healthcare, sadly. Your oral surgeon's billing department should submit the records and know the appropriate lingo required to meet the insurance carrier's criteria: that's their job and I would ask them. That's what my surgeon's billing department did for me and after two appeals, I was finally approved.
Braces removed for 3rd and final time July 14, 2016!!!!

Permanent 8 crowns front 8 teeth (upper) January 30, 2015

Braces removed again December 3, 2014!!

Partial braces re-installation September 25, 2014

Braces removed September 4, 2014!

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boodles8
Posts: 139
Joined: Thu Jul 25, 2013 4:10 pm

Re: Oral surgeon consult - and insurance question.

#3 Post by boodles8 »

I had lower jaw only, so a bit different case for recovery. But I would NOT have been ok to go back to work at 2 weeks. I could talk just fine, but my energy level was zippo. Of course, my situation was complicated by how terribly my body handles pain meds and anesthesia, so I didn't get much nutrition in the first nine days. That said, I have yet to hear of anyone--upper, lower, or both--who would have been able to return to work in two weeks, let alone one. I think these surgeons are optimistic because they see us all the time and don't realize what an abnormal state jaw surgery recovery is for a person.
Boodles8

Braced July, 2012
BSSO August, 2013
Debraced October 2, 2014

Alicia110613
Posts: 101
Joined: Sat Oct 26, 2013 8:26 am

Re: Oral surgeon consult - and insurance question.

#4 Post by Alicia110613 »

One week sounds soooo short! I had lower jaw surgery only (BSSO) and I felt relatively o-k and started doing a few hours of work after 1 week, but was still really puffy and wasn't well enough to return to work full time yet. I went back to work after 2 weeks -- same with two other folks I know personally who had jaw surgeries. I also don't talk extensively at work so if you do, it's best to stay home longer if you can in my opinion.

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parsleysage
Posts: 351
Joined: Tue Mar 18, 2014 10:42 am
Location: Virginia

Re: Oral surgeon consult - and insurance question.

#5 Post by parsleysage »

Thank you all! I totally agree about the recovery time. I have no idea at all why he would say 1 week. I hope they will sign my paperwork for at least 3 weeks off. My jaw already starts to ache by the end of the day and my mouth gets dry, too. (I do a lot of talking, haha, I'm a supervisor too so I have to be at 100% to handle and resolve the escalated issues.)

Thanks anyway for the insurance question... I know that no one can answer it besides Aetna! Fingers crossed! Is it a good sign they covered my consult? I wouldn't think it was covered at all based on others' experiences.

sirwired
Posts: 2104
Joined: Thu Oct 30, 2008 10:05 am

Re: Oral surgeon consult - and insurance question.

#6 Post by sirwired »

With my LeFort I I was comfortably back at work in two weeks, but I could not have done it before then.

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