Ready for Surgery!

[tyler3178]

So, I finally got the "OK!" from my ortho, but I have some questions regarding insurance. I have Anthem and I have read the criteria for treatment, but I have no idea if I meet them. How do you guys find out your overjet(I don't know if thats the correct word). Does the insurance look at before or after braces? I had to get some teeth pulled to make room for my teeth, which in result did cause my bite to become worse. Thank you in advance for responding !

[EWUgal15]

I had my surgeon's office send in a pre-authorization for my surgery when I went in for my initial consult. That's the best way to get an estimate of what your insurance will cover. I know that the surgeon's office included the measurements my orthodontist took prior to receiving any orthodontic treatment. I also had a pre-existing condition waiting period that had to be cleared before treatment could take place. This was only for the surgery. I am paying for my braces 100% out of pocket. Because orthognathic surgery is often in conjunction with braces, I would imagine that they wold go off of measurements taken before braces treatment because the braces will exaggerate the problem in order to correct it, but I don't know for sure. You should be able to call your insurance company and ask them how qualification for a benefit is determined. If you haven't requested a pre-authorization, I would start with a phone call and ask specific questions about the benefit. I would also have your surgeon's office send in a pre-authorization. That will make it easier for your surgeon's office to submit the claim and get it paid.

Congrats on being ready for surgery though! That's a major milestone! Unfortunately for me, my pre-authorization was almost a year before any surgery was expected to take place. Now I'm stuck waiting for another pre-authorization to come through and I still haven't scheduled my surgery. My surgeon says I'm ready, but the orthodontist hasn't signed off yet. Hopefully they will tomorrow so I can get the ball rolling...or at least give me a time frame that I could potentially schedule surgery for so that I can get paperwork for my job squared away.

[sirwired]

During your OMFS consult the office will make all the appropriate measurements; some come from sticking a specialized ruler on your face and scribbling down a bunch of numbers, others come by marking up your current lateral and P-A ceph's. After your measurements are taken, you can discuss them with the OMFS if you like. They'll take care of getting the pre-auth from the insurance company.

When I went through Anthem pre-auth, the OMFS office forgot to include some of my measurements; after they did that, I got my pre-auth letter in about a week. (I was about as happy as the day I got my first job offer! Did quite a happy-dance by the mailbox!)

[uncleezno]

One thing to be aware of - there's no monolithic 'Anthem'. There's more than a dozen, usually one per state, and on top of that, your plan can be completely different from someone else using the same Anthem provider as you.

As others have said, pre-auth will let you know what will be covered. If, like me, you meet the terms for medically necessary but your plan doesn't cover it, fight tooth and nail to get an exception. Insurers are garbage companies, and if you put up a real stink - politely - sometimes they'll bend the rules for you.