Metal Mouth Message Board

On this board, I've noticed that people that get covered have Blue Cross and Blue Shield. I also read that Kaiser covers this procedure. Where I live, I don't know anyone with Kaiser. My cousin is a medical billing specialist and has recently moved to the area where I live (midwest) and said she doesn't see Kaiser out here. I had Blue Cross and Blue Shield through my parents but because of my age, was kicked off. I now have UnitedHealthcare.

So I guess my question is, do any insurance companies besides Blue Cross and Kaiser cover this procedure? Again I'm asking because those two insurances get talked about most frequently on this board it seems.

BCBS is massive, especially in the Midwest states so that is what you're most likely to see. I personally don't know about United Healthcare, but I remember seeing a sign in my OS's office about United Healthcare. Now, that doesn't really mean anything on how they might pay for orthognathic surgery, but hopefully it gives you some glimpse that it is at least heard of around here.

I have also heard good things about Aetna.

The thing is, there is no universal truth with insurance. It is hit and miss sometimes, and a lot of it comes down to how the surgeon's staff goes about putting in the claim. But what I can tell you, is if you fight and keep records and you are willing to put in the time, you're likely to stand a good chance that some of your procedures would be covered.

Best of luck to you.

-Chicago29

WE have BCBS and our carrier won't be covering ANY oral surgery after the new year. They are putting it on their exclusions list. I had to fight to get mine done By December, because they tried to change my policy mid-year knowing I needed jaw surgery.

We did a *lot* of changing insurance during my son's treatment (due to work changes), and Independence Blue Cross out of PA was the only insurance that didn't exclude this surgery.

It was excluded by United Healthcare (at least the branch in OR), and by Prudential Health, and by one other one that I'm forgetting now. Also excluded by Regence Blue Cross in Oregon.

According to this - http://www.aetna.com/cpb/medical/data/1_99/0095.html - Aetna covers it in some cases.

I have Aetna and I had no problem getting my surgery approved. The whole process was painless (pardon the pun).

I have federal blue cross basic and they paid about 2200 out of 7800 for out of network doctor. They approved the surgery and out of network exception since they are no IN-Network doctors that perform this surgery...naturally. However, I only had to pay 500 for a $12,500 hospital bill so that's not too bad for me. Good luck! it's well worth it in the end.

Yikes ...anyway to avoid those hospital fees?

If your insurance doesn't cover your surgery, will they cover your hospital fees? Maybe a stupid question, but I don't understand how insurance companies work.

That isn't very likely and I've heard of hospital fees as high as $100,000 so be careful.

Well why are the fees so high for jaw surgery? I'm definitely confused. I had cosmetic surgery a few years ago and the hospital bill was cheap. Why would it be different for jaw surgery?

It really depends on your insurance. Fortunately for me, the hospital was in-network, but the doctor wasn't. Since the hospital bill was much higher, it turned out for the better. Really go into your benefit brochure and read your in/out of network benefits. Good luck!

You'll be on the operating table for longer. Staying a night or two in the hospital adds a few thousand. The implant plates and screws are very expensive(around $4,000). More complex operations require more hospital staff.

24braceface wrote:Well why are the fees so high for jaw surgery? I'm definitely confused. I had cosmetic surgery a few years ago and the hospital bill was cheap. Why would it be different for jaw surgery?

I would never call Orthognathic Surgery "cosmetic surgery". It is much more invasive than almost any purely "cosmetic" procedure. Take a minute and think what is actually being done with jaw surgery. Extensive models are taken and studied. Then, those models undergo a mock surgery, so that the surgeon knows what to do while you are being operated on. That takes hours of the surgeons time, which is big bucks. They know to the millimeter how they are going to move things before you are even in the OR. During the procedure (sorry to be graphic), the teeth bearing portions of your jaw are physically removed from your facial skeleton using a bone saw. Then, everything is put back together with very high precision screws/plates. These plates/screws cost $7000.00 for me, and I didn't even have plates on the bottom jaw. These must not be the screws you can go into your local Home Depot to buy

This isn't "tidying up the house"...jaw surgery is tearing the house down and starting anew. I'm sure some cosmetic procedures are rough, but I sincerely doubt they are like jaw surgery. All this means a lot more time in the OR, longer hospital stays, more hospital staff, time in the intensive care unit, and so on and so forth. In the US health care system, hours equate to thousands of dollars and you can quickly see how a bi-maxillary surgery ends up being in the $75K+ range for many people.

Now, I'm not saying this to scare you...Hundreds of people on this board have all had it done. You're going to do fine...but I am in the camp that believes you should set the proper expectation of what you're signing up for.

-Chicago29