How do you get insured for this treatment? It's cosmetic!?

[BigJaw]

I know this can be a complicated matter. I've been told I should have double-jaw surgery to correct an overbite. So that's great but I definitely don't have the money to pay for it. My surgeon said I should be covered by any medical insurer (as I am currently covered), but I just called them to explain the situation, then I suddenly hung up..... The reason I want this surgery mainly is because I don't like my weak jaw and chin. If I mention this to my insurer I really can't see them approving it!!? I'm told the surgery will correct my appearance and also give me better long-term oral health. The latter part I could possibly see being insure-friendly but I don't understand how everyone else is going about it? Do you mention the appearance factor with the health insurer or do you purely focus on medical reasons such as jaw deformity, TMJ, maloclussion etc etc.... I could really do with some help on how to approach this.

[HelenUK]

This surgery is not cosmetic. Anyone who thinks we would go through such major surgery for cosmetic reasons is wrong. How about the bite issues, pain, headaches, tooth erosion and loss, difficulty eating and sleeping...

[bmueller]

I dont know where you're from, but I'm in the US and I never personally called my insurance company. The surgeon files for an authorization. In this authorization, they submit photos, molds of your teeth and a writeup of other issues related to the jaw placement and measures from your face. The insurance company has criteria for whether or not you condition is "medically necessary" and if your case meets that criteria, they approve your surgery. You can also add letters and documents from other doctors which demostrate this will benefit your health, for example, ENT writes how it will improve breathing by increasing airway etc.

If your bite is significant enough that your Ortho says you need surgery, you probably have a situation that will fit medical necessity.

[katsface]

It's your surgeon's job to make the case on your behalf. Calling the insurance company won't get you very far in my experience.

Unfortunately, the only way to really, officially KNOW that your insurance will pay for the surgery is to start the process and have your surgeon send in paperwork to get insurance approval. They will make the argument for you that the procedure is medically necessary. If your surgeon said your insurance would cover it, it seems like he thinks it IS medically necessary, as insurance doesn't typically cover purely cosmetic procedures. But I'll warn you, my surgeon told me that even though he could easily make a case that my procedures were medically necessary, the insurance co. might still reject it and not pay. He said Insurance companies are covering fewer and fewer cases in recent years to try to cut costs.

To be clear, people DO have these procedures as purely cosmetic surgery. And I don't think you should feel bad, or feel like you have to justify yourself if you are primarily concerned with the cosmetic effects of the surgery. It's your face. If something really bothers you, and you're prepared for the procedure/risk/recovery/cost, then you shouldn't feel bad about trying to fix it.

But, a jaw/smile/bite that isn't cosmetically pleasing can also be detrimental to health in some way. If your bite is bad enough, or you can prove sleep apnea, or other breathing problems due to your jaw formation, your insurance company may consider the procedure medically necessary and cover it. If your surgeon cannot show that your bite is bad enough, your insurance may consider it a cosmetic procedure and not cover it at all. And like I said, even if your surgeon thinks it's medically necessary, your insurance company may still decline your approval.