Metal Mouth Message Board

Hello everyone...

Can someone help out with explaining how insurance companies go about finding out whether your condition is pre-existing. Yes, technical my condition is pre-existing since I've known that i had a bite problem since i was 19 now 25. My dentist even mentioned it back then that i might want to see an ortho which i did but when he mentioned jaw surgery my mom was like NO WAY! And could never afford such a surgery on my own. So here i am 6 years later.

Currently, I've had a few ortho consults and recommended 5 out of 6 orthos to really consider jaw surgery. The only thing that I have done so far was take x-rays, pics, diagnostics, moldings which was paid out of pocket since i was laid off about a month ago and do not have medical/dental insurance. Do you think if I decided to buy independent insurance right now to cover jaw surgery in say the next 8-12 months this would be considered a pre-existing condition? I have not chosen to start treatment with any orthodontist as yet. Like I mentioned, I've only taken x-rays and diagos (paid out of pocket) and had a few consults. I've never had anything done to my teeth or paid for regarding this issue with any past insurance companies.

Also, do you think if I had a consult with a oral surgeon before i buy insurance they can find out seeing as any type of consult fee i would pay out of pocket? I'm just trying to figure if there is some kind of technicality they can get me on to say this is pre-existing. I'm not sure if others are going through the same situation but any help, feedback, or thoughts on this would be really appreciated.

it'll be a pre-existing condition since you already have it (and it's not from, for instance, an injury you incurred after getting insurance). When my insurance pre-approved my surgery, I had to send in a certificate of prior insurance coverage since it's a pre-existing condition. once you get insured you'll probably have to wait a specified number of months before they'll cover it if you don't have insurance now.

Where are you guys from? I'm from Australia and I took out insurance especially for the jaw surgery.

In Australia we have the pre-existing condition rule, but the insurance will cover it after 12 months of membership with that particular private health insurance company. For example, I have Medibank Private, and I can't claim certain things after a period of say 2 months for general dental. And with teeth extractions it was a 12 month wait, so I had to pay for my extractions. But with the pre-existing condition rule I have to wait 12 months to even consider having the jaw surgery. Which is ok because I haven't even gotten my braces on yet and I've had the insurance for around 3 months now. By the time I need the surgery it'll be covered.

I could go with the public health system but I won't be able to choose my surgeon, which is important to me because I want the surgery to be performed by somebody other than a medical student.

I'm in the US. I had different insurance before I switched to my current insurance, so they have to cover my pre-existing conditions. Otherwise I think it would be an 18 month wait (not sure on the time period though).