[quote="snapdresser"][quote="TylerWithBraces"][quote="snapdresser"]Hold the bus. What exactly is the "birth defect" here? Because even if it occurred naturally that doesn't mean you can't get it covered under various other criteria. Do you have a Class II/III malocclusion? Have you ever been tested for sleep apnea? Have you looked at the specific orthognathic requirements for your policy to cover it?
Anyone have any experience with BCBS in Pennsylvania?
As to your question, I would expect it to be at least $20k out of pocket. As far as I know, only the surgeon is sometimes willing to negotiate for patients without insurance, but I could be wrong.[/quote]
I have class III malocclusion. My policy specifically excludes oral surgery for congenital malformations. AKA something i was born with. AKA my underbite.
My plan is to get my insurance company to pay for the hospital fees & the anesthesia fees since i am covered for those things. Though i am worried if they won't under the circumstances that my surgery is an uncovered service.
No I haven't been tested for sleep apnea. I most likely don't have it although i may sometimes experience symptoms. I would need to be studied.[/quote]
Generally speaking, I think the insurance companies don't consider a Class III malocclusion to be congenital, considering you weren't born with any teeth to be malocclused... You're far from the only person to have to deal with an insurance company that excludes congenital malformations and a lot of people were still able to get coverage, even if they had to file multiple appeals. But if you're thoroughly discouraged and don't want to bother with trying to get insurance to cover it, then by all means shell out the $$,$$$. If they consider your surgery to be elective (not medically necessary), they're not going to cover your hospital or anesthesia either. I didn't think I could get mine covered for sleep apnea either, but I went in for a sleep study, turned out to be positive, and saved almost $100,000 cuz of it. That said, just taking out a massive medical loan and paying out of pocket is probably easier
Go for it, champ.[/quote]
I am definitely not willing to shell out a lot of money. I am optimistic about my insurance however. I do believe i can get some coverage I'll just have to wait and see. Im not due for surgery for atleast a year. Everyone seems to have a completely unique case with their insurance.
