Insurance madness/ Surgeon recommendations?

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#1 Post by **siredred** » Thu Apr 29, 2010 5:40 pm

Hi all!

I've been lurking here for some time and decided just now it's time I start getting involved and start posting.

I had a consult with Dr. Gunson a few months ago and want to have surgery with him as I was very impressed and felt at ease. However, paying for this surgery is a different story.

I have Blue Cross Blue Shield of Texas and I was told they do not cover much and don't give any financial information out until the surgery is booked and paid for by me. They mentioned that because I'm in Texas it's going to be even harder for me to get any coverage.

However, there is no in network oral surgeon where I live and the closest one is 600-800 miles away in San Antonio/Houston. I can travel the same distance in the opposite direction and be in California from where I live.

Has anyone had any experience with Blue Cross Blue Shield trying to get surgery covered in a different state than where you live? I'm trying to find viable alternatives but I'm not comfortable having surgery with just anyone.

Any ideas or recommendations? I'm looking to purchase new insurance if necessary. Also, has anyone had successful surgery with any doctor in Texas? I'm open to traveling anywhere so long as I'm in good hands and my insurance covers a good portion of the procedure.

I've already compiled a list of some well known surgeons (Arnett/Gunson, Posnick, Schendel, Super) but wonder if I'm missing any others?

Thanks a lot guys!

#2 Post by **cvn** » Thu Apr 29, 2010 7:29 pm

I think blue cross pretty dependably covers about 10k normally of an arnett/gunson surgery, which isn't much of a dent, but it's something. Their insurance person probably told you something to the effect of that. My blue cross covered 18k of it, but I'm a mess of a redo and my overall fee was pretty crazy, even by their standards.

Dr. Wolford is in Texas (dallas iirc) and has a pretty terrific reputation though - you should probably look into that as it's instate.

#3 Post by **Marisama** » Thu Apr 29, 2010 7:40 pm

I am very interested in this post as well. I saw Dr. Gunson and am in Utah, hoping to move to Houston if all goes well with my job interviews. I don't feel comfortable with just any surgeon. I've seen Wolford as well. Any insight is appreciated.

#4 Post by **siredred** » Fri Apr 30, 2010 9:57 am

cvn, you're right. I was told the max BCBS has paid Gunson was about 12k and as low as $1,200 but they don't release any financial info until I pay in full which pretty much sucks.

RYANvaughn, what did you think about Dr. Wolford? And Gunson? Who did you feel more comfortable with. I heard he was just as expensive but also stellar.

I want to get a great functional outcome but also reap some cosmetic benefits as well and so far I think Gunson addresses both with his philosophy and approach. Plus, his before and after photos are amazing!

I'm guessing it's best to get another insurance policy with a different company. I hear Aetna pays a large portion of the surgery.

Thanks guys!

#5 Post by **Marisama** » Fri Apr 30, 2010 2:20 pm

siredred wrote: RYANvaughn, what did you think about Dr. Wolford? And Gunson? Who did you feel more comfortable with. I heard he was just as expensive but also stellar.

I was impressed by both surgeon's thoroughness and care. Dr. Wolford wanted to perform disc articulation (Mitek Anchors) and I wasn't ready to operate on my TMJ's. Dr. Gunson wanted to perform the same double jaw surgery to correct my asymmetry but didn't want to mess with my joints. Both wanted to use a method called "counter clockwise rotation." I felt more comfortable with Dr. Gunson and I am planning on having surgery with Gunson if I can afford it.

#6 Post by **siredred** » Mon May 03, 2010 10:11 am

That's good to hear. I know I've heard Wolford likes to do a lot of TMJ work but I'm not sure I'd like to mess with my joints either. I pray that my insurance covers a big portion of surgery with Dr. G; he's the only I've consulted with but still feel he's the one.

#7 Post by **Marisama** » Mon May 03, 2010 10:48 am

What are your exact reasons for seeking surgery?

#8 Post by **siredred** » Tue May 04, 2010 5:03 pm

I have sleep apnea that is caused by both jaws being underdeveloped. My tongue falls into the airway when I sleep because there's not enough space. I personally think it's due to all the steroids I took since age 4 to help with my asthma and allergies. Apparently, it's bad for bone.

Also, my left jaw joint gets sore and feels like it pops out of place and gets fatigued when I chew a lot due to my bite still being off despite five years in braces. Dr. G says I have some facial asymmetry because of it.

Basically, braces could never fully fix what my ortho tried to fix. I'm still upset about it, to be honest.

I also had a chin implant put in a year ago thinking that my problem was that I had no chin but I was wrong; it's my small jaw. So now I have to look at getting that removed as well.

What a bummer!
-E

#9 Post by **Marisama** » Tue May 04, 2010 5:27 pm

Minus the chin implant, I have the exact same problem. My right jaw joint has become painful and has been that way for years due to asymmetry. My right side is about 5mm longer vertically than the left, which makes for an uncomfortable bite. I am confident that surgery will fix my bite and will in turn help my painful joints.

Keep in touch. It's nice to find people that are dealing with the same problems and are taking similar steps to finally fix this.

Ryan

#10 Post by **sahar** » Tue May 04, 2010 5:55 pm

I M frostrated by the amount of money of almost 35000 only for surgery, im more worried about money that anything else, cant sleep at night:(

I can change my insurance through my work by next week, ANY IDEA WHICH INSURANCE WOULD COVER THIS SURGERY THE MOST??

Tks a lot

#11 Post by **siredred** » Tue May 04, 2010 8:29 pm

Ryan,
Wow, 5mm sounds like it's pretty bad. Do you see it in your face? I always wondered why my nose pulled a little to the left (even more so after nose surgery - they thought that would fix the sleep apnea) and Dr. G was able to tell me instantly that my face wasn't really lined up.

Shar,
I feel you. I'm stressed out figuring out how to pay for this surgery. It's medically necessary but seems like the best docs are out of network. I hear Aetna is pretty good with paying a decent portion. I looked into buying some insurance with them and it's actually cheaper than what I pay now for BCBS.

If I win the Texas lotto tonight (200 mill) I will pay for everyone's surgery! ; )

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Insurance madness/ Surgeon recommendations?

Insurance madness/ Surgeon recommendations?

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