Would insurance cover braces and not surgery?

[HoneyBee245]

I got full approval for my braces, but they have not sent out pre approval for my surgery yet. I’m eight months in a one year treatment. I’m going to make an appointment with my surgeon for him to send out pre approval request. My fear is of course my surgery won’t be approve and I’m left worse off than I was, because I can’t bite normally anymore at all and I’ve develpped speech problems. I always did have chewing problems but not this severe. I have Medicaid I’m scared they won’t covee the surgery since it’s so expensive. Do any of you know if it’s common for them to cover braces and not surgery?

[SDFD TSchott]

I could be wrong but who knows I personally don't think they will cover it unless it's 'Medically Necessary'. I know with my own insurance they will not cover it unless 'Medically Necessary' however they covered up to 1,500 for my braces.

[HoneyBee245]

Isn’t not being able to eat or speak medically necessary or is that not considered that?

[SDFD TSchott]

Depends on how the insurance company sees it. My son is going through speech therapy and insurance denied his claim saying it's not Medically Necessary even though he has difficulties and is Autistic

[kplatt2010]

Hi HoneyBee,
The best person to answer whether Medicaid will pay will be the surgeon. I would imagine that medicaid would have similar qualifications for why they would pay for the surgery as commercial health insurance.

I have BCBS federal and I know in my particular case, the surgeon had shared with me that sometimes the insurance companies may initially deny requiring the surgeon to submit additional details to qualify. In my case though, I remember when I went back that he told me I would not have an issue qualifying as the ortho had over-corrected significantly and that this would qualify me alone.

Take it one step at a time, you've been doing the necessary steps to get the issue corrected. It may be approved right off or you might have to have the surgeon submit additional documentation. Don't give up. You've come this far.
Karla