Metal Mouth Message Board

I know that most on here can appreciate the insurance "dance" that I've been through. I switched jobs (and insurance) after my surgery had been approved late last year. The new job switched insurance companies again at the beginning of the year, so that has been 3 insurance policies that I've had since October. I just got a call that my surgery is approved and that they will consider my surgeon in-network even though he is currently out-of-network! I have to say that I hate dealing with insurance companies in general but this new one has been awesome to contact. They are friendly over the phone and informative. I questioned why there were no in-network surgeons in my area and they immediately looked into the matter, called me back in 15 minutes and approved my surgeon. You don't see service like that any more...

So, surgery was originally set for December, but it looks like it may be sooner; maybe the summer.

Unlike others on here, I have a supportive family. They are behind me 100% on this journey. At the same time, they can't exactly appreciate what I'm going through as I know that many of you can relate.

Congratulations...I had much the same experience and so far I only have great words about my insurance company as well (but I'll save any dancing until I see they've paid the claims as I just had surgery!).

It is the shame of our health system that others have had to fight to get coverage for these procedures, and when I hear that I really root for the patient. For those of you that have had to fight, know that the harder you fight the better chances you have, and there are many stories on here with people winning appeals. So, never give up!

A word of advice to everybody that has to play the insurance game - Some carriers do not have Oral & Maxillofacial Surgeons as part of their network in specific states. I don't know the reason for this, but that was my situation. I found a surgeon, only to find out they were not in network. After some research I found there were NO OMS providers in my State.

I called the insurance company and they made an "in network" exception since I was forced to go with an out of network provider. So, if your case is for medical necessity and you cannot find a provider within a reasonable distance, DO YOURSELF A FAVOR AND CALL THE INSURANCE COMPANY AND ASK FOR AN IN-NETWORK EXCEPTION!

Granted, I will still have a lot of out of pocket expense for the surgical fees, as my insurance company cannot make the provider only charge the negotiated rate of other in network providers. But, having the claim paid as "in network" versus "out of network" is sure to save you money. And you could always ask your provider to accept the insurance payment as payment in full.

Wow that is great news for you. If you dont mind me asking, what insurance company are you currently with?

evilinany...I am not sure if that question was targeted to me or the person that started this thread. But in case it was for me, my carrier is Anthem Blue Cross (Blue Cross of California). I live in Chicagoland, but my company is based in CA. I would suspect the situation would have been similar no matter what specific Blue Cross/Blue Shield carrier is involved.

evelinany - I also used Anthem Blue Cross. In my case, it was Blue Cross of Pennsylvania, even though I live in Ohio. You should be able to call your current insurance company and get an idea if orthognathic surgery is covered by your plan. But, first, call the oral surgeons office and get the procedure codes for your specific surgery. You can give these codes to the insurance company and they can let you know whether orthognathic surgery is covered and if there are any exclusions. Don't know what chicago29's experience was but my claim had to be reviewed to ensure that it was not cosmetic in nature otherwise, there were no exclusions. Good luck!