Aetna only approved my lower jaw surgery and denied the upper and septoplasty. I will still have to pay around 4-5K out of pocket for this surgery.
I live near Kaiser Oakland and I heard Kaiser covers 100%. Is it safe to assume that since Aetna approved it - Kaiser will approve it also? (At least the lower jaw)
Enrollment period is coming up and I can switch my insurance company in November.
My ortho says I should be ready for surgery next summer. I'll be able to start using Kaiser in Jan - would that be enough time to get the prep work and schedule a date for surgery? Is it difficult to book a date over the summer?
Have approval from Aetna, considering Kaiser
Moderator: bbsadmin
I'm not the expert on insurance. But if aetna approved it I can't imagine Kaiser turning you down. I don't know how the pre-existing condition thing works but since you are covered by your company I would think you are safe.
I will be having my surgery with Kaiser Oakland in December.
Keep in mind that there is about a 6 month lead time in scheduling with Kaiser. Plus you will have to get a consultation which can be a least a month wait. So you could be good to go by summer if your insurance starts in January. You might check with Kaiser about scheduling an appointment before your insurance goes into affect. I think I remember reading somewhere that someone actually scheduled an appointment and got the green light before they switched insurance, but I could be wrong.
Call the maxillofacial department at Kaiser Oakland--the number should be on their website. I'm sure that department could answer all of your questions and they are very nice once you get a hold of someone to talk to (they get busy).
I will be having my surgery with Kaiser Oakland in December.
Keep in mind that there is about a 6 month lead time in scheduling with Kaiser. Plus you will have to get a consultation which can be a least a month wait. So you could be good to go by summer if your insurance starts in January. You might check with Kaiser about scheduling an appointment before your insurance goes into affect. I think I remember reading somewhere that someone actually scheduled an appointment and got the green light before they switched insurance, but I could be wrong.
Call the maxillofacial department at Kaiser Oakland--the number should be on their website. I'm sure that department could answer all of your questions and they are very nice once you get a hold of someone to talk to (they get busy).
Check and see the time required before you can operate on a pre existing condition with the kaiser plan. I have stayed on blue cross cobra because if i were to swap to a normal plan, I would have had to wait something ridiculous like 18m or 2 years on the swapped plan before I could have surgery. I don't know about you, but I'd rather pay a little extra than have to wait.
Ask to see the plan booklet for the kaiser plan and read it over with a fine toothed comb. It should all be in there.
Ask to see the plan booklet for the kaiser plan and read it over with a fine toothed comb. It should all be in there.
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NorthBayWired
- Posts: 3
- Joined: Thu Sep 03, 2009 10:22 pm
Kaiser Oakland Jaw Surgery
I just had surgery done through Kaiser Oakland on Sept. 10. You will have to get a referral from your primary care physician for the consultation with the oral surgeon but should not be a problem.
The care has been great. They are very experienced in these surgeries.
The care has been great. They are very experienced in these surgeries.
Just updating this for reference in case anyone else has a similar question in the future.
My OS appealed Aetna's decision and now I have both jaws covered, unfortunately it'll still be 15K.
I called Kaiser and they said if Aetna approved it, they likely will approve it also.
I'm still switching to Kaiser cause 15K is ridiculous and I've read good reviews about Kaiser.
My OS appealed Aetna's decision and now I have both jaws covered, unfortunately it'll still be 15K.
I called Kaiser and they said if Aetna approved it, they likely will approve it also.
I'm still switching to Kaiser cause 15K is ridiculous and I've read good reviews about Kaiser.
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2bpositive
- Posts: 87
- Joined: Sun Aug 10, 2008 5:31 pm
Oakland Kaiser has an excellent Maxillofacial Department I was told this even before I had Kaiser insurance before I had braces just trying to figure out what to do about my bite ( or I should say no bite since I did not have one).
I had my surgery in July all I had to pay was my $5.00 co pay and when I was going home they billed me for my Medication to take home which was 2 medications that came up to $20.00.
I had a 5 month wait for surgery but they had a cancellation so I was moved up to only a 3 month wait.
They have a class for you a few weeks before your surgery that gives you lots of info about the surgery ( I had already learned lot just by reading all the stories here on this message board). They will also give you a few things you will need after the surgery.
Very happy with my surgeon she was very easy to talk to always answered my e-mails she was great!
I had my surgery in July all I had to pay was my $5.00 co pay and when I was going home they billed me for my Medication to take home which was 2 medications that came up to $20.00.
I had a 5 month wait for surgery but they had a cancellation so I was moved up to only a 3 month wait.
They have a class for you a few weeks before your surgery that gives you lots of info about the surgery ( I had already learned lot just by reading all the stories here on this message board). They will also give you a few things you will need after the surgery.
Very happy with my surgeon she was very easy to talk to always answered my e-mails she was great!
Braces: Aug. 1, 2008
Surgery: July 30, 2009
Lefort I
Mandibular Osteotomy
Sliding Genio
Debraced: Feb. 23, 2010
Surgery: July 30, 2009
Lefort I
Mandibular Osteotomy
Sliding Genio
Debraced: Feb. 23, 2010
My open enrollment period just came up and I made the switch from Healthnet HMO to Kaiser HMO. I've attempted with Healthnet, and let's say I got no where. From reading what I've read at various message boards, I've decided to make the switch to Kaiser. I'll be an official Kaiser member January 1st 2010!
I went to see my orthodontist in November. He came up with a road map:
1. See Kaiser PCP and get referral. Ortho will email referral once PCP and Kaiser number is available. I hope getting a referral from PCP will not be difficult.
2. Speak w/ oral surgeon. Apparently, there is a new Maxillofacial Department at the Santa Clara Kaiser (San Jose, CA). Dr. Desai is the surgeon I am to ask for. (Does anyone know of him and his reputation?). Called the office last week to see how long the wait list is to see Dr. Desai and it was only one week. I've heard for Dr. O'Ryan at Kaiser, it can take up to one year? (I have heard great things about her).
3. When and if accepted to the program, start braces with ortho for about one year.
4. Surgery
5. Braces one year after surgery.
I know some individuals start braces before even seeing surgeon, but overall, do you think this is a logical road map?
Take care!
I went to see my orthodontist in November. He came up with a road map:
1. See Kaiser PCP and get referral. Ortho will email referral once PCP and Kaiser number is available. I hope getting a referral from PCP will not be difficult.
2. Speak w/ oral surgeon. Apparently, there is a new Maxillofacial Department at the Santa Clara Kaiser (San Jose, CA). Dr. Desai is the surgeon I am to ask for. (Does anyone know of him and his reputation?). Called the office last week to see how long the wait list is to see Dr. Desai and it was only one week. I've heard for Dr. O'Ryan at Kaiser, it can take up to one year? (I have heard great things about her).
3. When and if accepted to the program, start braces with ortho for about one year.
4. Surgery
5. Braces one year after surgery.
I know some individuals start braces before even seeing surgeon, but overall, do you think this is a logical road map?
Take care!
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HkyGrl s2k
- Posts: 90
- Joined: Sun Feb 03, 2008 1:20 pm
- Location: San Jose, Ca.
- Contact:
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2bpositive
- Posts: 87
- Joined: Sun Aug 10, 2008 5:31 pm
Dr. Felice O'Ryan is the best!! She did my surgury at the Oakland Kaiser I live 40 minutes from there. Dr. O'Ryan is very easy to talk to, answers your e-mails, and I'm very happy with how she moved both Jaws and my sliding Genio. She and my Ortho worked together in the pass so this was a bonus to me. I feel very lucky to have them both.
Braces: Aug. 1, 2008
Surgery: July 30, 2009
Lefort I
Mandibular Osteotomy
Sliding Genio
Debraced: Feb. 23, 2010
Surgery: July 30, 2009
Lefort I
Mandibular Osteotomy
Sliding Genio
Debraced: Feb. 23, 2010
I'm quite excited to make the change to Kaiser. I'm much more hopeful with the slight possibility of having this surgery from your responses. I've initiated this process 8 years ago - when I was 17 years old. I went to see an oral surgeon, Dr. Lee and Dr. Fujimoto; I was a good candidate, insurance (under my parents at that time) approved, but the surgeons were worried my jaw may still continue to develop and grow. So, it was put off.
After finishing college and internship, I moved back to the bay area. Got a job and insured. Went to revisit the whole issue, but I guess I made the wrong decision with health insurance - started with Healthnet HMO. Went to see the same surgeons and was informed Healthnet HMO will not cover the procedure. I really had to show an actual need for it ie) to the point I can't eat, significant weight loss w/ evidenced of low albumin, etc. Surgeons believe I am a good candidate, but it's the head honchos who are sticklers with approvals. (Small World) My supervisor at work apparently had the procedure done; denial of insurance and she ultimately had the procedure done. She worked extensively previously w/ Fujimoto/Lee, but was denied by Blue Cross PPO 2 times. She had braces on and ultimately made the decision to proceed and paid 70K out of pocket. 5 years to pay off that! I can't imagine spending that much money.
I've started my flex pay account and will put money away for 2010; let's hope Kaiser approves and my money will not go to waste!!
I have a cross bite; narrow upper jaw and wide lower jaw; lower jaw is asymmetrical and larger to the left side. TMJ to right side w/ clicking and popping. Occasional locking of the jaw; sometimes w/ pain.
That's awesome, Attackred, that your from San Jose! Check out the department at the San Jose. There are profiles on the surgeons on the website. As HkyGrl s2k mentioned, Dr. Bui, is too from the Santa Clara Kaiser - with Dr. Desai. My orthodontist is Dr. Sasaki from Los Gatos. He's familiar w/ working with Dr. O'Ryan and has been working with Dr. Desai.
Oh one last question, if anyone can answer. For those who have done the procedure, what did you have to present to your PCP in terms of s/sx (if any) for a referral? I read some insurance will exclude if any TMJ is presented, while others need that dx for further evidence for the need of the procedure.
Do keep us posted with your events, keeps my momentum going with this surgery =).
Thanks for your responses, and thanks in advance for further responses.
After finishing college and internship, I moved back to the bay area. Got a job and insured. Went to revisit the whole issue, but I guess I made the wrong decision with health insurance - started with Healthnet HMO. Went to see the same surgeons and was informed Healthnet HMO will not cover the procedure. I really had to show an actual need for it ie) to the point I can't eat, significant weight loss w/ evidenced of low albumin, etc. Surgeons believe I am a good candidate, but it's the head honchos who are sticklers with approvals. (Small World) My supervisor at work apparently had the procedure done; denial of insurance and she ultimately had the procedure done. She worked extensively previously w/ Fujimoto/Lee, but was denied by Blue Cross PPO 2 times. She had braces on and ultimately made the decision to proceed and paid 70K out of pocket. 5 years to pay off that! I can't imagine spending that much money.
I've started my flex pay account and will put money away for 2010; let's hope Kaiser approves and my money will not go to waste!!
I have a cross bite; narrow upper jaw and wide lower jaw; lower jaw is asymmetrical and larger to the left side. TMJ to right side w/ clicking and popping. Occasional locking of the jaw; sometimes w/ pain.
That's awesome, Attackred, that your from San Jose! Check out the department at the San Jose. There are profiles on the surgeons on the website. As HkyGrl s2k mentioned, Dr. Bui, is too from the Santa Clara Kaiser - with Dr. Desai. My orthodontist is Dr. Sasaki from Los Gatos. He's familiar w/ working with Dr. O'Ryan and has been working with Dr. Desai.
Oh one last question, if anyone can answer. For those who have done the procedure, what did you have to present to your PCP in terms of s/sx (if any) for a referral? I read some insurance will exclude if any TMJ is presented, while others need that dx for further evidence for the need of the procedure.
Do keep us posted with your events, keeps my momentum going with this surgery =).
Thanks for your responses, and thanks in advance for further responses.
Hope your doing well =). Sorry, initially overlooked you just had your surgery on Monday! Yikes. But I can assume everything is going well, since you're up and about typing in the forum =p.HkyGrl s2k wrote:Santa Clara is pretty nice. I originally saw Dr. Desai, but he got over booked so he transferred my case to Dr. Bui so I could have my surgery before the new year. Had my surgery in Oakland on Monday with Dr. Bui and Dr. Liberty from Sacramento. Both Doctors were great.
boatsink, I'm also starting the whole surgery process and I also have Kaiser Permanente, but in southern CA. My PCP referred me to the maxillofacial department just today and all I did was send him a nice email explaining that I was undergoing orthodontic treatment and required a consultation with a maxillofacial surgeon.
Couldn't have been easier.
Couldn't have been easier.