Metal Mouth Message Board

I'm in that starting to worry about “all the what if'sâ€

Yes, my insurance covered the genioplasty. My surgeon submitted the procedure with the others but didn't expect them to pay for it. I fully expected to pay for it but lucked out. However, my surgeon cut his fee in half since I was having upper and lower jaw surgery as well. I beleive the genio would have been a little over $1,000 if I paid out of pocket.

I have really good insurance also, and I just got word back Friday that they are not going to cover the genio. My cost for it will be $3650.00, but please remember that I'm in Alaska where medical costs are 40% higher then the rest of the U.S. Most likely your cost would be half of mine. Genio is done almost exclusively to balance out the profile and symmetry of ones face. Other then the medical implications (as in my sleep apnea case) most insurance companies consider it to be a cosmetic procedure and will not cover it. Sometimes it is a crap shoot though, I know people whose insurance said they would not cover it, yet when it was submitted they paid. So..go figure. Even though my insurance denied the genio portion, they are going to wait, submit it, and see what happens. If they don't pay then I will be responsible. You will want your OS to do a pre-auth for all of your treatment before you start, that way you will know what is covered. If they approve it, and then the treatment plan changes along the way, they will most likely allow any change as it would be a continuation of treatment for you.

I was originally scheduled for SARPE and lower jaw advancement, then the doctor changed it it to upper, lower, and genio. Insurance agreed to the changes with no issues at all since the treatment had already been previously approved and was in progress. Don't start anything without pre-auth, or you could end up half way through treatment with no insurance help.

Brandy

The $1000 price sounds so much better than the $3500. Who knows maybe a miracle will occur and it will be covered. Of course with my luck they'll decide to exclude the surgery just prior to my date.

Mike

I didn't end up having genio, but if I had it would have cost $2650.

Good luck!

If you know you need the surgery done then go ahead and get pre authorized now. I got pre-auth 2 years before I actually got the surgery!
It was all part of my orthodontic treament that got submitted.

My insurance did cover Genio as far as I know. IMind you, it's not cheap!
But then again, my family and I have still to get denied for anything.
Only this year (after 6!) did they stop covering my braces.

Good luck getting approved! I hope it works out!

I think my genio was covered 75% by the government under some "disability insurance" and it was $1500 CND dollars.

I recommend you have your insurance pre-approved prior to surgery. Most insurance companies will cover orthognathic surgery, whether one or two jaw surgery. The oral surgeon will submit the pre-treament for the procedure after he evaluates. Normally the surgeon makes the final determination on whether it is a one or two jaw surgery. Two jaw surgeries are not as common, but done on a regular basis.
You also can call you insurance admin to find out if it is covered. If it is a definite no, they will say so. Usually they say they want the surgeon's recommendation to make the decision. If that is the case, you are pretty much OK.

If it is not covered , it is a very expensive undertaking. You need all your ducks in a row before starting unless you have money to burn. The orthdontics is not normally covered and if so, only a small portion. The surgery is normally covered according to your deductible.

PS I have been working with insurance companies in US for over 30 years in this very area. This may not apply elsewhere.

I know the jaw surgery will be covered. I'm not sure how they'll react to the geno. I'm just trying to learn the reasons it is and isn't covered.

Mike

It will not be covered if the insurance company feels it is for cosmetic reasons only. Anyone requiring a genioplasty would require orthodontic treatment plus surgery to improve their occlusion or bite to maintain dental health over a lifetime.

It may also not be covered if your plan does not cover this type of medical problem as stated in your policy.