Which Kaiser Plan will cover my Jaw Surgery? Please help

[ivonne]

I've had braces for some time and my Ortho said I will most likely need surgery to fix my bite.
I need to get insurance and I was recommended that
Kaiser in Oakland is one of the best to get the surgery done.

Unfortunately I am not understanding the plans under Kaiser's website and I don't think I can call
and ask about which one of all might cover the surgery? (because you cannot mention surgery or that you plan to have one right?)

1- What Kaiser plan will cover the surgery?

2- How much is the total cost of the surgery (without insurance) so I get an idea of the expenses of the surgery without and with an insurance company
since I would still need to pay out of pocket something...


Thank you so so much!

[Alicia110613]

I think what you need to do is to ask for a copy of the detailed plan, specifically ask for sections that talk what services are covered, and sections that talk about exclusions.

You'll need to read over the details to see whether each plan has a specific exclusion for orthognathic surgery. Some plans will say it covers the surgery if it is "medically necessary", while others will have a specific exclusion regardless of medical necessity.

[LyraM45]

I am getting my surgery with Dr. Felice O'Ryan up at Kaiser Oakland. Just got my date for April 9th. My situation sounds similar to yours as I started treatment with my orthodontist with an insurance that wasn't kaiser. I could have gone with a few other surgeons that he works with, but with my case, he really felt I should switch to Kaiser and see Dr. O'Ryan. Lucky for me I didn't have to wait the full year to switch since my husband got a new job and we just picked up Kaiser with him. I think it's just the regular Kaiser HMO. I didn't even realize they had different plans. I thought their HMO was their HMO and that is that. Anyway, I was able to get picked up, get referred right up to see her within the month, and my surgery has been put through with no questions asked. Everything was pretty straight forward.

I live in the south bay. If you want to PM me and get my info, I'd be happy to message back or even meet up for coffee to run you through what you need to do regarding the whole insurance mess!


PS-- who's your ortho? That would be a trip if we happen to be at the same office somehow!

[Laria]

Hi Ivonne,

I have Kaiser HMO in Southern California. Your cost will depend on the plan you choose and the co-pay that comes with the plan. Please feel free to contact me if you want additional information.

Laria

[ivonne]

Hello Everyone, sorry it took me so long to reply!!!!! I had forgotten my password info.

I did Kaiser, I had no employment that would pay for it (I'm self employed) I chose the Platinum option, it was quite expensive about $500 a month total (but without Obamacare). I chose this option
because you only pay $290 as a copay for the surgery. Other options have a cheaper monthly payment but you can end up paying $6,000 for the surgery or more since they total out of pocket will be that.
If you are getting Kaiser to cover for the surgery make sure to ask your orthodontic when you would be ready for Kaiser to see you, calculate your monthly payments and out of pocket maximum for the best option for you.
Now, I've heard that Kaiser has a long wait time specifically with Felice o'Ryan or the top doctors there, if it takes about a year for the surgery date then calculate what's the best co-pay and monthly option for you as a total.

I had my surgery already, I am still healing.

[pantlover]

for anyone else that is looking to switch to Kaiser for surgery, Kaiser only has HMO plans. they all cover the surgery. but your actual copay/coinsurance will vary depending on how good your plan is. Luckily, I have Kaiser through my employer so my projected cost for outpatient surgery is only ~$15. So unless Kaiser suddenly changes their policies concerning orthognathic surgery, you will never pay for the entire surgery out of pocket with them.

i swear i'm not a Kaiser spokesperson. even one of my orthos straight up said that he suggests that his patients switch to Kaiser solely on the basis of how good they are about covering the surgery.

[tinymandibleAZ]

Kaiser P insurance is awesome as far as orthognathic surgery goes -- at least, that's what I've been reading for years.

Unfortunately, K-P insurance is not available in Arizona.

[LyraM45]

I can not believe I have never come back and updated this thread, but I ended up getting my double jaw surgery with Felice O'Ryan up at Kaiser Oakland in April 2014. It was a disaster, and the care I got from Kaiser from start to finish (where they abandoned me and hung me out to dry after the surgical result was catastrophic and made me worse than what I went in to fix!) was sub standard and down right negligent in many ways. I had to put together a while new team and do a complete retreatment, including a full double jaw revision surgery, which I just had in Feb 2016. Luckily I found an amazing surgeon and he was able to pull a rabbit out of his hat and fix me better than he even planned for my treatment, but now after having to go through this nightmare, I can't scream at the top of my lungs enough: AVOID KAISER. Please, do yourself a favor, and get a good surgeon. You may find an OK surgeon with Kaiser, but because of the way Kaiser is set up (with too many patients and very factory like), that surgeon is never going to have the proper time to invest in the planning and execution of your case and give you at least the standard of care you deserve for jaw surgery. Is Kaiser good at covering jaw surgery with no questions asked? Yep, but buyer beware. Sometimes you get what you paid for. At least I did!

Please visit my website if you'd like to know more on my story and more info on care with Kaiser vs. care outside of Kaiser. http://www.confessionsofametalmouth.com

[kpw818]

Personally, I have had a better experience with Kaiser and a Kaiser surgeon than the other two surgeons I saw. Now, I haven't had surgery yet, but the pre-op experience has been fantastic.

[Ralphtc]

Currently in the same situation if I have the kaiser HMO 90 plan will I have to pay the max out of pocket ? Or just the co payment

[Ssre]

I’ve kaiser too and going to see a surgeon for consultation for orthognathic surgery. Do they really cover any orthognathic surgery even if it’s cosmetic?

[angeloca12]

Im getting Kaiser Platinum, do you know how long it takes to actually get the surgery. Its 500 a month , was wondering how many months I am going to have to pay ? Thank you .