Metal Mouth Message Board

Hi guys. I'm just posting this to get some opinions. I am currently waiting to get jaw surgery. I have my braces on and I will most likely be getting double jaw surgery but i'm not 100% sure yet if it will be double jaw surgery. In fact I have no idea which procedures I am going to be getting done (I am about 1 year till jaw surgery). I have paid for EVERYTHING 100% so far except the surgery. Braces and everything else is paid off atm.

Unfortunately my BCBS policy specifically excludes any surgeries for birth defects. So I am not getting covered for the actual surgery, but I will be covered for the hospital fee at 80% (which I hear is the most expensive part). How much do you think I will be paying for out of pocket for the surgery? I live in the Pittsburgh area in Pennsylvania, and I am getting my surgery done in a Pittsburgh hospital (Allegheny Hospital) So I can expect to pay atleast 10-15k for the surgery, and an additional amount for the hospital fee. Maybe I can make a deal with the hospital?

Please let me know if you think negotiating my surgery is possible, and if you have done it for your case.
Thanks!

Hold the bus. What exactly is the "birth defect" here? Because even if it occurred naturally that doesn't mean you can't get it covered under various other criteria. Do you have a Class II/III malocclusion? Have you ever been tested for sleep apnea? Have you looked at the specific orthognathic requirements for your policy to cover it?

Anyone have any experience with BCBS in Pennsylvania?

As to your question, I would expect it to be at least $20k out of pocket. As far as I know, only the surgeon is sometimes willing to negotiate for patients without insurance, but I could be wrong.

[quote="snapdresser"]Hold the bus. What exactly is the "birth defect" here? Because even if it occurred naturally that doesn't mean you can't get it covered under various other criteria. Do you have a Class II/III malocclusion? Have you ever been tested for sleep apnea? Have you looked at the specific orthognathic requirements for your policy to cover it?

Anyone have any experience with BCBS in Pennsylvania?

As to your question, I would expect it to be at least $20k out of pocket. As far as I know, only the surgeon is sometimes willing to negotiate for patients without insurance, but I could be wrong.[/quote]

I have class III malocclusion. My policy specifically excludes oral surgery for congenital malformations. AKA something i was born with. AKA my underbite.

My plan is to get my insurance company to pay for the hospital fees & the anesthesia fees since i am covered for those things. Though i am worried if they won't under the circumstances that my surgery is an uncovered service.

No I haven't been tested for sleep apnea. I most likely don't have it although i may sometimes experience symptoms. I would need to be studied.

TylerWithBraces wrote:

snapdresser wrote:Hold the bus. What exactly is the "birth defect" here? Because even if it occurred naturally that doesn't mean you can't get it covered under various other criteria. Do you have a Class II/III malocclusion? Have you ever been tested for sleep apnea? Have you looked at the specific orthognathic requirements for your policy to cover it?

Anyone have any experience with BCBS in Pennsylvania?

As to your question, I would expect it to be at least $20k out of pocket. As far as I know, only the surgeon is sometimes willing to negotiate for patients without insurance, but I could be wrong.

I have class III malocclusion. My policy specifically excludes oral surgery for congenital malformations. AKA something i was born with. AKA my underbite.

My plan is to get my insurance company to pay for the hospital fees & the anesthesia fees since i am covered for those things. Though i am worried if they won't under the circumstances that my surgery is an uncovered service.

No I haven't been tested for sleep apnea. I most likely don't have it although i may sometimes experience symptoms. I would need to be studied.

Generally speaking, I think the insurance companies don't consider a Class III malocclusion to be congenital, considering you weren't born with any teeth to be malocclused... You're far from the only person to have to deal with an insurance company that excludes congenital malformations and a lot of people were still able to get coverage, even if they had to file multiple appeals. But if you're thoroughly discouraged and don't want to bother with trying to get insurance to cover it, then by all means shell out the $$,$$$. If they consider your surgery to be elective (not medically necessary), they're not going to cover your hospital or anesthesia either. I didn't think I could get mine covered for sleep apnea either, but I went in for a sleep study, turned out to be positive, and saved almost $100,000 cuz of it. That said, just taking out a massive medical loan and paying out of pocket is probably easier Go for it, champ.

[quote="snapdresser"][quote="TylerWithBraces"][quote="snapdresser"]Hold the bus. What exactly is the "birth defect" here? Because even if it occurred naturally that doesn't mean you can't get it covered under various other criteria. Do you have a Class II/III malocclusion? Have you ever been tested for sleep apnea? Have you looked at the specific orthognathic requirements for your policy to cover it?

Anyone have any experience with BCBS in Pennsylvania?

As to your question, I would expect it to be at least $20k out of pocket. As far as I know, only the surgeon is sometimes willing to negotiate for patients without insurance, but I could be wrong.[/quote]

I have class III malocclusion. My policy specifically excludes oral surgery for congenital malformations. AKA something i was born with. AKA my underbite.

My plan is to get my insurance company to pay for the hospital fees & the anesthesia fees since i am covered for those things. Though i am worried if they won't under the circumstances that my surgery is an uncovered service.

No I haven't been tested for sleep apnea. I most likely don't have it although i may sometimes experience symptoms. I would need to be studied.[/quote]

Generally speaking, I think the insurance companies don't consider a Class III malocclusion to be congenital, considering you weren't born with any teeth to be malocclused... You're far from the only person to have to deal with an insurance company that excludes congenital malformations and a lot of people were still able to get coverage, even if they had to file multiple appeals. But if you're thoroughly discouraged and don't want to bother with trying to get insurance to cover it, then by all means shell out the $$,$$$. If they consider your surgery to be elective (not medically necessary), they're not going to cover your hospital or anesthesia either. I didn't think I could get mine covered for sleep apnea either, but I went in for a sleep study, turned out to be positive, and saved almost $100,000 cuz of it. That said, just taking out a massive medical loan and paying out of pocket is probably easier Go for it, champ.[/quote]

I am definitely not willing to shell out a lot of money. I am optimistic about my insurance however. I do believe i can get some coverage I'll just have to wait and see. Im not due for surgery for atleast a year. Everyone seems to have a completely unique case with their insurance.