Metal Mouth Message Board

I need to go for a double jaw surgery for an underbite and I'm wondering if anyone in Ontario Canada has gone through this.

What is and is not covered by OHIP? I'm getting different information from different people. I've heard that surgery itself is covered but not hospital stays and preparation fees for the surgeon, or that the surgery and hospital fees are covered but pre and post operative cares are not covered etc.

I'm wondering if anyone knows exactly what is covered by OHIP, the fees to which I need to pay the surgeon

It's all covered by ohip except for about $1600-2000 - for oral surgeon visits, records...

Yes, that was my experience as well. The surgery is covered. Pre & post op visits to the surgeon are not (approx $2000). The anesthesia is not supposed to be covered either (approx $400) but the hospital may not bill you for it.

The entire surgery is covered by OHIP (surgery, hospital stay, anaesthesia, etc etc)

What other people may mean by the hospital stay not being covered is that if you're only covered by OHIP (ie no additional private or employer health insurance), then you're only covered for the "general ward" which is normally 4 beds per room.

If you have additional employer/private health insurance, you're USUALLY covered for a semi-private ward (which is 2 beds/room).

You always have the option, regardless of your coverage to pay additional fees to request a semi-private or private room, but I've found that the cost between a general to a semi-private is much more (around $150, from what I remember) than the difference between a semi-private to a private (which was around $25, i think).
Again, the costs difference between general to semi to private all depends on that particular hospital.


What is NOT covered by OHIP are the costs of the braces (again, if you have private/employer insurance you're usually reiumbursed 50% of the cost to a maximum between $1500 to $7500, depending on your level of coverage.

What IS NOT covered by OHIP is the surgeon's fees (which is generally for case planning, post-surgical care, etc etc), which depending on the surgery I've seen range from around $1500 to $4000.

My own double surgery (for a class 3) is going to be $3500.

If you see my other thread, I'm currently going back and forth and sending estimate after estimate to my private insurance to see how much of THAT will be covered.

i had about 2000 of surgeon fees prior to surgery that wasnt covered by OHIP or my own coverage but you can claim in on income tax

candycin wrote:i had about 2000 of surgeon fees prior to surgery that wasnt covered by OHIP or my own coverage but you can claim in on income tax

Was the surgeon's fees $2000 and none of it was covered by your own coverage?

Or were the surgeon's fees higher and your insurance covered it except for $2000?

I'm trying to get a feel for how much of the surgeon's fees are covered by people's private/employer health policies.

I have a form that says OHIP provides coverage for:
1. Hospitalization
2. anesthetic fees
3. The basic surgical fee
They also provide for one visit to the patient in the hospital and one visit to the patient in the hospital after surgery.

I also have a form from my surgeon that shows everything not covered by OHIP. It adds up to $1754

Keep in mind that this total only includes mandibular surgery and 3 post op visits. It's an extra $650 for maxillary and an extra $100 for each post op visit

These may be covered by other insurance/dental plans.

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I hope this helps

for me there was some stuff covered by Great west life but I am capped for 1600 a year i paid 2000 out of my own pocket that was after i had already submitted a claim for other things such as dental cleaning, the start up fees with the surgeon etc....like i said i claimed the rest on my income tax ....

LeahRuth wrote:
I also have a form from my surgeon that shows everything not covered by OHIP. It adds up to $1754

LeahRuth -- did you have any additional insurance (private or employer) that you submitted the $1754 to?
If so, was any of it covered?

I get $1500 from Sunlife but I believe that was all used on my braces.
I'm 19 so my parents are in charge of this.. not too sure about the details.

great west life rejected my additional expenses.- I tried twice to submit them.