No Insurance - Which Insurance Company would cover?

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#1 Post by **consumetake** » Fri Feb 20, 2009 1:57 am

I want Jaw Surgery. I have no insurance.
How would I know which dental insurance would cover the cost of the Jaw Surgery?

Aetna, Cigna, Delta - were some insurance companies I had found.

Which insurance company will allow payment towards Jaw Surgery?
How much is Jaw Surgery?

I live in Northern California.

#2 Post by **Skitters** » Fri Feb 20, 2009 5:18 am

I don't really have an answer for you, but I do know that you DO NOT need dental insurance for this surgery. It will all be charges for MEDICAL insurance.

For what it's worth, I had LEFORT I and BSSO and the hospital charges were $94,000 (yikes!) and the surgeon fees were $5,000. My insurance covered it all, thank GOODNESS. I have the government policy with highmark blue cross/blue shield.

Good luck with everything! Wish I could be more help to you, but I'm sure someone here has more knowledge than me and will respond!

#3 Post by **chicago29** » Fri Feb 20, 2009 7:00 am

Consumetake,

Whatever you do, do NOT get any consultations about your jaw conditions until you are insured. Also, if you tell the insurance company "Hey, I'm thinking about jaw surgery so I need to know if it is covered", I assure you that it will end up being treated as a pre-existing condition and excluded.

What you need to do is shop around and ask each carrier for their Certificate of Insurance, and read it carefully to ensure Orthognathic Surgery is not specifically excluded. If you live in CA, I believe it is harder to explicitly exclude conditions in a policy, so it may not be as much of a concern (I'm not sure about this, just going on what I was told by somebody).

Also, as skitters pointed out you don't need Dental as that won't cover any of this, except for perhaps $1000 to $2000 for the braces (which is going to be a costly policy if you get an individual dental policy that includes adult orthodontia).

By the way, you WILL need braces if you need corrective jaw surgery. If you don't think you need braces, then I can almost assure you that your surgery would be considered cosmetic and no policy on earth will cover a cosmetic procedure.

Best of luck to you...and if you only remember one thing, DO NOT SEEK CONSULTATION for your jaw conditions until you are insured!

#4 Post by **consumetake** » Sun Feb 22, 2009 5:09 pm

What I am getting at is check up on the medical insurance to see will they cover jaw surgery, then get that insurance, after that.. find a oral surgeon.

#5 Post by **chicago29** » Sun Feb 22, 2009 6:00 pm

Sounds like a good plan! Good luck to you and let us know how your search turns out.

Regards
Chicago29

#6 Post by **consumetake** » Mon Feb 23, 2009 1:25 pm

What medical insurance do you recommend that has a chance it will help me out in the Jaw Surgery cover fee?

#7 Post by **almost50** » Mon Feb 23, 2009 7:47 pm

Kaiser will cover the jaw surgery if it's approved and they are a lot easier about it than what I've been reading with other insurance companies. Once the Kaiser surgeon approves it, your good to go.

I'm due to have jaw surgery in 7-8 months or so with them in Oakland.

They are medical and not dental, so they won't cover the orthodontics.

#8 Post by **consumetake** » Mon Feb 23, 2009 8:38 pm

How would you know is it a medical or cosmetic condition?
My jaw is similar to this guy's:
http://www.fatbrowne.com/jaw.jpg

Do the doctor and patient sometimes "team up" and try to "convince" the insurance it is for medical condition?

A lot of things happen under the table.. I am curious since I am new to this. I had braces when I was in high school, now almost 35, my jaw still sticks out a little.

#9 Post by **consumetake** » Mon Feb 23, 2009 8:53 pm

almost50 wrote:Kaiser will cover the jaw surgery if it's approved and they are a lot easier about it than what I've been reading with other insurance companies. Once the Kaiser surgeon approves it, your good to go.

I'm due to have jaw surgery in 7-8 months or so with them in Oakland.

They are medical and not dental, so they won't cover the orthodontics.

which doctor are you planning to go to?

#10 Post by **almost50** » Tue Feb 24, 2009 7:49 am

If your case is similar to that picture, it's not just cosmetic since it appears that there is quite an underbite. And in such a situation you would need a combination of jaw surgery and braces. No surgeon will perform such an operation without combining it with braces because to move the lower jaw back surgically would shift all of the teeth attached to that jaw back as well, and your bite would be different.

I would first get a couple of opinions from orthodontitsts and see what they say. If your bite is perfect and it is just cosmetic you would be hard pressed to find any insurance company that would cover it.

#11 Post by **consumetake** » Tue Feb 24, 2009 12:48 pm

Here is a picture of my jaw:
http://i606.photobucket.com/albums/tt14 ... ke/Jaw.jpg

there is a open space when I put my lips together. Also, my jaw is slightly shifted to one side.

From the side view, the bottom lips looks bigger then the top lips.

I was thinking about going with an temporary medical insurance plan for six months. CoreHealthInsurance.com is around $75.70/month

As I was reading on here:
http://www.sasid.com/BHI2.0/fsg_BHI_val ... ummary.htm

it says

Plan Limitations and Exclusions Applicable To All Benefits

Benefits will not be paid for charges or loss caused by, or resulting from, any of the following:

(11) Dental care, x-rays, or treatment other than Injury to natural teeth and gums resulting from an accidental Injury and rendered within 6-months of the Injury;

(20) Cosmetic surgery. This Exclusion does not apply to reconstructive surgery:

(21) The repair or replacement of existing artificial limbs, orthopedic braces, or orthotic devices; dentures, partial dentures, braces or fixed or removable bridges;

........................................................

Please give me an advice you have. Thanks.

#12 Post by **almost50** » Tue Feb 24, 2009 1:53 pm

Sounds like there are issues with your teeth as well as your jaw.

My advice:
See an orthodontist first. Then figure out your insurance issues if it is determined that you need surgery.

#13 Post by **fendigirl** » Wed Feb 25, 2009 11:32 pm

Hi Everyone,

Just found this board after a search. I live in the bay and it's been a sure thing for years that I need orthagnathic surgery. I have Kaiser insurance and I've been cleared by by surgeon @ Kaiser Oakland. Problem is, I need to go into braces for the 3rd time and the quote that I've been given is approx $10,000!!!! That's a lot to swallow especially now.

I'm looking for recommendations for a reasonable orthodontist who has experience working with orthagnathic patients.

Thanks in advance!!!!

#14 Post by **consumetake** » Thu Feb 26, 2009 1:29 am

fendigirl wrote:Hi Everyone,

Just found this board after a search. I live in the bay and it's been a sure thing for years that I need orthagnathic surgery. I have Kaiser insurance and I've been cleared by by surgeon @ Kaiser Oakland. Problem is, I need to go into braces for the 3rd time and the quote that I've been given is approx $10,000!!!! That's a lot to swallow especially now.

I'm looking for recommendations for a reasonable orthodontist who has experience working with orthagnathic patients.

Thanks in advance!!!!

$10,000 for braces or jaw surgery?

#15 Post by **fendigirl** » Thu Feb 26, 2009 9:34 am

braces