Canadian Insurance

[tofino]

Hi All.

Are there any Canadians out there (particularly those in BC) who have managed to get their insurer to cover part or all of orthognathic surgery? Is this surgery ever classified as medically necessary?

Thanks and Cheers

Glen

[csblackburn]

Hi All.

Are there any Canadians out there (particularly those in BC) who have managed to get their insurer to cover part or all of orthognathic surgery? Is this surgery ever classified as medically necessary?

Thanks and Cheers

Glen

Glen,

I'm a B.C.'er who is getting my Class III corrected as well. My health insurance (yours should be the same) is covering everything except the surgeon's cost. My surgeon has told me that my cost will be somewhere between $4,000 and $7,000 depending on whether I will need one or both jaws done. The current plan is to correct the Maxilla (upper) and wait until the braces have done their thing to see if the lower jaw will need correcting.

Of course, none of the orthodontic costs are covered and my dental insurance through my employer doesn't cover orthodontics for adults.

If there is anything else I can help you with, please let me know.

Cary

[tofino]

Thanks Cary.

Is your guy cash up front, or will he finance?

Cheers

Glen

[csblackburn]

I don't think my oral surgeon will finance and I'm sure I will be billed afterwards like I have been so far. I've had 2 bicuspids removed in his office for room and 4 wisdom teeth removed in surgery in the hospital by him. Each time, except for the wisdom teeth removal, I've been billed afterwards.

Orthodontics can be financed, but I paid for it all up front so that I wouldn't back out. I have a tendency to chicken out on medical things.

Cary

[jaws]

Hi tofino,

First: Do you live in Tofino? (I'm assuming you do since that's your name!). You are VERY lucky! I visited Tofino a couple of years ago (drove there from Victoria), and camped beside the ocean. I can honestly say that Tofino is one of the most beautiful places I've visited!

About ortho insurance--I'm in Ontario, and none of my ortho is covered. I have a health plan through my University (I'm a grad student), which covers some of my regular dental costs, but no ortho. I have a financing agreement with my ortho where I paid $1000 up front and I pay $200 a month until the full $6000 is covered.

[tofino]

Thanks Cary and Jaws.

Cary: My orthodontics is going well and I am financing some of the roughly $7000.00 CDN fee. Looks like I'll have to dig deep for the surgeon however!

Jaws: Tofino is where I surf, and I concur on its natural beauty. I live and work on the Sunshine Coast (you know, Gibsons Landing, Molly's Reach, Beachcombers, all that)

Cheers

Glen

[geekgirl]

Hey - I haven't explicitly gotten to the surgery part of my treatment yet, and I'm not sure I've even going to do it yet. But I too have been told that medical covers everything but the surgeon's fee, and that my surgery (to correct a class II overbite) will cost between $5000 and $7000, depending on what exactly needs to be done.

I too have been wondering if i could figure if there's any situations in which MSP will pay more, or to see if they'd cover any of my ortho. From the BC Med web page (http://www.hlth.gov.bc.ca/msp/infoben/benefits.html#top) I found that what's covered is:
- dental and oral surgery, when medically required to be performed in hospital*;
- orthodontic services related to severe congenital facial abnormalities.

I still don't understand why the surgeon's fee is not included in the first point, but from everyone I've talked to, it's not. And unless you've had severe problems since birth, you're on your own with the ortho.

I'm in Langley right now, but I spent a year or so in port alberni, and got out to Tofino quite a bit while i was there. It's absolutely gorgeous, that's for sure. If you don't mind the rain, of course, but that holds true for most of the province

[tofino]

Hi geekgirl, and thanks for this information.

(Btw, You have a great brace blog developing)

I am wondering if I can beat the system by pushing and arguing a bit. Somebody, somewhere, has to make a judgment about "severe congenital deformities" in the dentition. Who makes this decision? I have heard (but not seen confirmation) that if there are troubling psychological issues associated with any type of deformity, then MSP can pick up the tab.
(Hey, maybe my pre-extraction photo is sufficiently traumatizing *lol*)

From the beginning I was told that my occlusion will get worse during treatment and that if I didn't have the surgery the final results could be much less than satisfactory. So I guess I'll do it.

Cheers

Glen

[peanut]

Hi Tofino,

I'm not from BC, so I can't make any suggestions about the Insurance. This has already been mentioned in my thread about 'Surgery in September', but I'm really surprised that surgeon's fees aren't covered in BC.

Do you have private insurance that might cover the fees? My private insurance doesn't pay for any orthodontics, but they covered my initial appointment with my surgeon, and any periodontal work I needed to have done. Perhaps if you have private Insurance, that might help you out?

I had to travel from New Brunswick to Halifax, Nova Scotia for my surgery, but I was covered under NB Medicare rules because that is where I am a resident. I have to pay for my wisdom teeth removal, but that is all, and since I already had an operating room and anathetic paid for by the surgery, I didn't have those added expenses, so it was only $320 to get my wisdom teeth out. The rest of the surgery was 100% covered by NB Medicare.

I can't really help much with your insurance questions, but if you have other questions about the surgery and recovery, I can certainly share my experiences with you there.

best of luck as you figure this all out,
peanut

[csblackburn]

I'm in Langley right now, but I spent a year or so in port alberni, and got out to Tofino quite a bit while i was there. It's absolutely gorgeous, that's for sure. If you don't mind the rain, of course, but that holds true for most of the province

It's interesting you live in Langley, although I don't, but my oral surgeon is based in Langley and I have to drive over the river to see him.

Cary

[tofino]

Hi Peanut, and thanks for your post.

I am covered by Pacific Blue Cross, with 90% Basic and 50% Restorative. Orthodontics is covered 50% but only up to $1000.00 lifetime. I left a few messages with PBC regarding orthognathic surgery, but they didn't reply. I am going to continue pursuing this however.

Cheers

Glen

P.S. BC has no monopoly on natural beauty - your end of the country is just as pretty, just flatter!

[geekgirl]

It's interesting you live in Langley, although I don't, but my oral surgeon is based in Langley and I have to drive over the river to see him.

Cary

LOL... my condolences. Isn't the bridge traffic fun?

[csblackburn]

LOL... my condolences. Isn't the bridge traffic fun?

Bridge traffic? I take the ferry that I have to wait 30 minutes for or I drive through Mission and Abbotsford if it's too long of a wait.

[geekgirl]

LOL... my condolences. Isn't the bridge traffic fun?

Bridge traffic? I take the ferry that I have to wait 30 minutes for or I drive through Mission and Abbotsford if it's too long of a wait.

Sorry - I assumed you were in Vancouver proper, and were taking the Port Mann bridge, the most evil of all bridges...

[smile]

Same ol' same ol' here in BC too - paying for me surgeons fees and orthodontics all out of my pockets. Aboot $17,000.

And hmm, there's a ferry to Langley now? Intersting.. I've only taken the ferry to Victoria. (feels dumb) My god, I sound like a tourist and I've been here for 10 years.

The port mann's a lovely bridge isn't it? I used to mix it up with the other one all the time.. the other orange one.. what was its name again? Anyhoo, aren't they twinning the port mann a few years down the road? Or doing something else to make the traffic better?
But I don't like the other bridge much better either.. (sorry, I'm bad with names) the one that's all narrow.. alexander something? Someone must know what I'm talking about here ;P