My wife has been going through the braces process for aprox 18 months and she is now ready for surgery. I have switched companies and my new insurance is pushing back on approving the surgery.
Does anyone have any suggestions on the correct verbage to convince the insurance company to do the right thing?
She needs to have her jaw alignment fixed so she has proper contact between her teeth.
working with the insurance company
Moderator: bbsadmin
Find the section in your insurance company's Terms that discusses orthognathic surgery and highlight the exact words the insurance company uses to determine whether or not they cover it and under what conditions. Then find an oral surgeon (preferably in their network) to write (or sign) a letter that says your wife needs exactly (verbatim) what they cover because she has the exact condition (verbatim) they cover it for.
Here's a related thread you may or may not find useful:
viewtopic.php?t=26917
Good luck.
Here's a related thread you may or may not find useful:
viewtopic.php?t=26917
Good luck.
Has she had any car/bike/sporting accidents in the past that one could argue contributed to her current bite?
I don't know where you live but $15K is a good price by southern california standards. I had 3-piece upper & lower done and it was $12,500. (Doesn't include the $2500 for the genio.) That was at a University Hospital too so it was considered a low-ball cost.
Here are some more threads you may find informative.
Paying for Surgery
viewtopic.php?t=26717
Cost of Surgery
viewtopic.php?t=23716
I don't know where you live but $15K is a good price by southern california standards. I had 3-piece upper & lower done and it was $12,500. (Doesn't include the $2500 for the genio.) That was at a University Hospital too so it was considered a low-ball cost.
Here are some more threads you may find informative.
Paying for Surgery
viewtopic.php?t=26717
Cost of Surgery
viewtopic.php?t=23716
Even more bummed.... I've had no luck with the insurance company so I think I'm SOL.
And the Dr. informed us that the now (16k) is just for him and doesn't include the hospital stay, other dr.s
My wife and I arre so bummed, we feel like we are **&##-ed (insert bad word here...)
Can anyone recommend a good Dr. in the Austin TX area that we can get a second opinion from?
And the Dr. informed us that the now (16k) is just for him and doesn't include the hospital stay, other dr.s
My wife and I arre so bummed, we feel like we are **&##-ed (insert bad word here...)
Can anyone recommend a good Dr. in the Austin TX area that we can get a second opinion from?
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Steph-in-WI
- Posts: 95
- Joined: Mon Aug 06, 2007 3:36 pm
- Location: Wisconsin, USA
- Contact:
I don't know of anyone in Austin, but I have heard of Dr. Day in Phoenix, AZ who gives very discounted rates to people without insurance. I believe he is able to do this partly because he does the procedure in his own facility so it reduces the hospital bill. I do realize that this would require some traveling on your part, but it is an option. His website is http://www.dr-day.com/.
You can also consider the "surgery tourism" option, there are several people on this site who have gone to Costa Rica to have the procedure done.
There have also been suggestions to look into teaching hospitals, as the care is often very good but the prices significantly reduced.
In any case, the procedures are quite expensive, but there are some options to reduce the cost. Is your wife scheduled to have upper jaw surgery, lower, or both?
I am sure this is very stressful given that she is ready for surgery but now you are battling the insurance issues. Best of luck as you sort this all out.
You can also consider the "surgery tourism" option, there are several people on this site who have gone to Costa Rica to have the procedure done.
There have also been suggestions to look into teaching hospitals, as the care is often very good but the prices significantly reduced.
In any case, the procedures are quite expensive, but there are some options to reduce the cost. Is your wife scheduled to have upper jaw surgery, lower, or both?
I am sure this is very stressful given that she is ready for surgery but now you are battling the insurance issues. Best of luck as you sort this all out.
That was an interesting post for Dr. Day. I have to admit there were some comments made in the video on his Orthognathic Surgery that I found to be very interesting. Specifically regarding recovery times and the like. He almost made the surgery sound "routine", which I am fully aware it is not.
By chance has anybody used Dr. Day as a surgeon, and can anybody attest to the work he does? Is there really anything "different" with his approach that somebody can elaborate on?
Chicago29
By chance has anybody used Dr. Day as a surgeon, and can anybody attest to the work he does? Is there really anything "different" with his approach that somebody can elaborate on?
Chicago29
I'm from Austin!!! I had my surgery in Austin!!!!!
Masher-
My insurance also didn't cover surgery, or hospital stay, but my surgeon did a bunch of sinus work (my septum was deviated, had upper jaw surgery + septoplasty + rhino + turbinectomy). It sucks, but it covered my hospital stay via insurance because the septoplasty/turbinectomy were actually covered by insurance! So I got my entire hospital stay covered (two nights) and my anesthesiologist costs, and I paid then just the 15k out of pocket for my jaw surgery portion. My upper was rather complex, so dunno if that's "par" for the course in cost for what your wife requires.
Anyway, I researched surgeons in Austin, Dallas, and Houston, for years and years, so feel free to send me a PM if you have any questions. The surgeon I went with was Dr. Widner since he had the sinus/upper experience I required most. You can see my before and afters below, I think he did a good job:)
Were you covered on the prior insurance btw? if you switched b/c work switched, you may be able to continue coverage for surgery despite the switch under an estoppel argument. I don't know for sure what you mean by "switching" IE voluntary or not?
Masher-
My insurance also didn't cover surgery, or hospital stay, but my surgeon did a bunch of sinus work (my septum was deviated, had upper jaw surgery + septoplasty + rhino + turbinectomy). It sucks, but it covered my hospital stay via insurance because the septoplasty/turbinectomy were actually covered by insurance! So I got my entire hospital stay covered (two nights) and my anesthesiologist costs, and I paid then just the 15k out of pocket for my jaw surgery portion. My upper was rather complex, so dunno if that's "par" for the course in cost for what your wife requires.
Anyway, I researched surgeons in Austin, Dallas, and Houston, for years and years, so feel free to send me a PM if you have any questions. The surgeon I went with was Dr. Widner since he had the sinus/upper experience I required most. You can see my before and afters below, I think he did a good job:)
Were you covered on the prior insurance btw? if you switched b/c work switched, you may be able to continue coverage for surgery despite the switch under an estoppel argument. I don't know for sure what you mean by "switching" IE voluntary or not?
My wife needs upper and lower jaw surgery. I switched jobs and move moved states voluntarily so I doubt an recourse with the old insurance company.
The Dr.Day site looks really good, I'm interested in finding out more. I can see driving or flying there as a definate option. The Costa Rica thing scares the crap out of us even though I'm sure it is fine.
The Dr.Day site looks really good, I'm interested in finding out more. I can see driving or flying there as a definate option. The Costa Rica thing scares the crap out of us even though I'm sure it is fine.
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Steph-in-WI
- Posts: 95
- Joined: Mon Aug 06, 2007 3:36 pm
- Location: Wisconsin, USA
- Contact:
There were a couple of people over on the Yahoo Orthognathic Surgery site that went to Dr. Day, I believe that is where I heard about him. I can't really vouch for him since I haven't been to him or even really looked around his website, but they seemed to be very pleased with their results. If you don't get any responses here from people who have used him, you might want to post on the Yahoo site.
Dr Day in Phoenix
Hi, I am new here but I am a patient of Dr Day and here's what I can tell you. First of all, he is a very good surgeon and I like him very much and would love for him to do my surgery if I could.
Here's the negative part......I have no health insurance(because of pre-existing condition I've been unable to get it). When I first saw Dr Day early this year, yes, they were using a surgical facility which was in the lower level of the building that he and several other surgeons shared. It was called Biltmore Surgical Center. Unfortunately, that surgical facility abruptly closed last May. They told me that it was because they were "undercharging" patients and could no longer stay in business. The surgical center where he now performs the surgeries is called "Greenbaum Surgical" and is almost double the price.
Originally, these were the costs I was quoted:
Dr Day's fee(upper and lower jaws) $15,200
Biltmore surgical center $5,163
Metro Anesthesia $1,007
Total $21,370
Here are the updated costs:
Dr Day $15,200
Greenbaum Surgical center $11,173 (huge jump in price here)
Anesthesia $1,216
Total $27,589
All costs have to be paid before surgery and Greenbaum requires at least half down.
After 2 years of orthodontics, I need to have my surgery soon but I just cannot afford to do it. I'm looking at Costa Rica now.
Looks like we're in the same situation. Best of luck to you!
Here's the negative part......I have no health insurance(because of pre-existing condition I've been unable to get it). When I first saw Dr Day early this year, yes, they were using a surgical facility which was in the lower level of the building that he and several other surgeons shared. It was called Biltmore Surgical Center. Unfortunately, that surgical facility abruptly closed last May. They told me that it was because they were "undercharging" patients and could no longer stay in business. The surgical center where he now performs the surgeries is called "Greenbaum Surgical" and is almost double the price.
Originally, these were the costs I was quoted:
Dr Day's fee(upper and lower jaws) $15,200
Biltmore surgical center $5,163
Metro Anesthesia $1,007
Total $21,370
Here are the updated costs:
Dr Day $15,200
Greenbaum Surgical center $11,173 (huge jump in price here)
Anesthesia $1,216
Total $27,589
All costs have to be paid before surgery and Greenbaum requires at least half down.
After 2 years of orthodontics, I need to have my surgery soon but I just cannot afford to do it. I'm looking at Costa Rica now.
Looks like we're in the same situation. Best of luck to you!
oops-double post sorry
oops
Last edited by OzzysMom on Mon Aug 04, 2008 10:29 pm, edited 1 time in total.