The surgery isn't covered, what to do?

Message

#1 Post by **ElenaM** » Tue Oct 20, 2009 12:46 pm

We sent 2 or 3 appeals and nothing. Is there anything we can do? We can't pay $20,000+.

#2 Post by **charlsie142** » Tue Oct 20, 2009 12:53 pm

I'm so sorry to hear that. I got two denial letters initially, saying it wasn't medically necessary, but I had my dentist write a letter on my behalf, and he spent a lot of time getting up to speed with my OD and OS (he's awesome!) on writing the letter and spent well over a month working on it, and somehow, it worked. Of course, things aren't perfect and my surgeon is out-of-network and I don't know how much my insurance will actually reimburse, but at least one thing has worked in my favor up to this point.

My OS and OD both wrote their own letters as well, so I think my insurance company just outright denied right off the bat and then got fed up with all the letters coming in. Luckily, I didn't have to write one myself. Now to just figure out how pay my deductible, etc.

Hopefully others will have better advice, but if you haven't already, ask anyone with any knowledge of your bite/teeth/jaw issues write a letter on your behalf.

Good luck to you! I feel your pain with $$...I'm the poorest of poor students (a PhD...aka poor hungry doctor).

#3 Post by **ElenaM** » Tue Oct 20, 2009 1:13 pm

Thanks. My plan says they do not cover it under any circumstances. It totally sucks. They used to 2 years ago.

#4 Post by **charlsie142** » Tue Oct 20, 2009 1:37 pm

Oh, no! I'm really sorry. Did you change your policy since two years ago?

Have you looked into medical tourism? I know OzzysMom had her surgery in Costa Rica with wonderful results at a deeply discounted price to what we pay in the US (assuming that's where you are). If you haven't already, take a look at her previous posts (using the search function you can search for a particular author). I was actually considering Costa Rica (Dr. Reiche) before I got my last letter. If you do look into medical tourism options, be sure to do lots of research.

#5 Post by PJ » Tue Oct 20, 2009 2:09 pm

I feel your pain--even with insurance, I ended up paying $9000 out of pocket.
Have you been able to see if they will at least cover the hospital charges? That will be the biggest expense--mine came to $34,000 for one night! If they do cover that, then another option (other than the good--medical tourism--that Charlsie told you about) is to find out if you can get a payment plan. My OS did offer something called Care Credit, I think, which supposedly has a low interest rate. I hope it all works out for you.

#6 Post by **ElenaM** » Tue Oct 20, 2009 11:34 pm

I'm a Canadian citizen and we have a house there. I wonder if we could get it done over there.

#7 Post by **32withbraces** » Wed Oct 21, 2009 12:45 pm

yep you can get it done in canada.great news its free in canada

#8 Post by **mas604** » Thu Oct 22, 2009 2:46 am

32withbraces wrote:yep you can get it done in canada.great news its free in canada

msp covers jaw surgery?

#9 Post by **Audra** » Thu Oct 22, 2009 7:01 am

Being a Canadian citizen does not entitle you to treatment. You have to actually live here in order to use the health care system.

#10 Post by **vtmike1283** » Mon Oct 26, 2009 7:18 pm

i had a similar problem with insurance. Didn't find out until the week before surgery either. i thought the hospital would have checked at the initial consultation.

I chose to go the Costa Rica path for a much cheaper solution. I'm down here now and 4 days post-surgery (double jaw). They treat you great here. It may not be free but it's much cheaper than $20k

#11 Post by **I love my teeth** » Tue Oct 27, 2009 9:36 am

Being a Canadian resident doesn't entitle you to the surgery either!! I am an american citizen (with US insurance) living in canada............we do not have canadian health care (because we have US insurance)..I saw the oral surgeon, who stated the office would "gladly" collect 100% of the cost of the surgery (hospital, anthesthesia, surgeon fee, ect) up front 30days prior to the surgery and pay the hospital out ect.... approx $20,000 CAD...when I told them my insurance would provide a guarantee of payment letter (no preauth needed) and pay them after the surgery, they said no way....I can use visa or MC to pay 30days prior........ummmmm--I don't think so!!!! So, being I am at least 8+ months away from a surgery date anyway (just got my braces on on May) I am working with the insurance company, the OD, and OS offices to work out something....because we are US expats in Canada we can use something called International SOS, which may be up front for me, and then settle out with Cigna later.....still working on the details....But definately, the answer is NO, you can't get the surgery covered unless you have the provincial health care!!

If after reading my ordeal, if anyone has any suggestions, I certainly would welcome them!! I really don't want to have to go to Washington State to get this done--I am afraid if there are complications, who wants to travel back over the border to get them resolved--ugh!!

#12 Post by **projo198** » Tue Oct 27, 2009 9:46 am

Sorry to hear... only advise I could give you is to join the militqary, LOL.. My doc said my surgery would have cost over $80,000 on the civilian side, and they also advanced my cheekbones during surgery which was totally cosmetic. To be honest the whole procedure was cosmetic I suppose, because although I had a horrible horrible underbite it didn't cause me any digestive or other problems.

Sorry to hear about your circunstances, are there no financing options for you? I see flyers everytime I'm in a doctors office..

#13 Post by **attackred** » Tue Oct 27, 2009 10:25 am

Try switching to another provider, it doesn't hurt to try.

I had Aetna only approve my lower jaw, I appealed and got both the upper/lower/midface approved.

I'm still switching to Kaiser cause it would be way cheaper to just pay the deductible.