Have approval from Aetna, considering Kaiser

This forum is for discussions relating to oral surgery for orthodontics.

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boatsink
Posts: 98
Joined: Sat May 23, 2009 11:56 am
Location: Bay Area, California

#16 Post by boatsink »

LAJaw wrote: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.
Sounds like a piece of cake. You didn't even have to go in to speak with him? That's awesome!

I assume I would need to go in though, since I've never met my PCP.

Thanks very much.

boatsink
Posts: 98
Joined: Sat May 23, 2009 11:56 am
Location: Bay Area, California

#17 Post by boatsink »

I made an appointment to see my PCP at Kaiser. This will be my first visit: January 5th, 2010.

I informed my orthodontist of my PCP and provided the information needed for a referral letter. I received the CC today in the mail addressed to my PCP: "he has a severe class III (underbite) malocclusion with a posterior cross-bite of his dentition on his left because of asymmetric growth of his mandible. He is experiencing popping of his right temporomandibular joint as a result of this malocclusion". Hope this warrants a referral.

One step at a time.

margan
Posts: 12
Joined: Thu Jan 07, 2010 10:47 pm

LA Kaiser

#18 Post by margan »

I posted earler about Kaiser's rejecting surgery for my severe overbite, tmd problem etc. because doctor said surgery is only done these days for people who can barely open their mouths.

So is his contention Kaiser's? Should I see another Kaiser Maxilofacial guy? I believe he's the only one in the LA Kaiser.
Thanks

attackred
Posts: 18
Joined: Wed Sep 09, 2009 9:15 am

Re: LA Kaiser

#19 Post by attackred »

margan wrote:I posted earler about Kaiser's rejecting surgery for my severe overbite, tmd problem etc. because doctor said surgery is only done these days for people who can barely open their mouths.

So is his contention Kaiser's? Should I see another Kaiser Maxilofacial guy? I believe he's the only one in the LA Kaiser.
Thanks
Can you request a second opinion from another doctor? are you eligible for surgery according to the guidelines? Can you get your ortho to write another letter strongly suggesting that you need it?


My own update:
The doctor had a phone conversation with my ortho, he mailed a referral to the Oakland Max Center. Now he says to "wait" for them to call me. I'm going to see if I can switch to Dr Desai in Santa Clara, Oakland is too far of a drive for me.

I'm going to call them early next week if I am not contacted by then.

attackred
Posts: 18
Joined: Wed Sep 09, 2009 9:15 am

Re: LA Kaiser

#20 Post by attackred »

margan wrote:I posted earler about Kaiser's rejecting surgery for my severe overbite, tmd problem etc. because doctor said surgery is only done these days for people who can barely open their mouths.

So is his contention Kaiser's? Should I see another Kaiser Maxilofacial guy? I believe he's the only one in the LA Kaiser.
Thanks
I just spoke with my coworker, she worked for a HMO previously. She said to just ask your primary care that you want a second opinion and he should refer you to another one.

attackred
Posts: 18
Joined: Wed Sep 09, 2009 9:15 am

#21 Post by attackred »

Note: I'm updating for future reference in case anyone else has this question later on.

Kaiser surgeon agreed that I needed surgery and I will have my surgery done this summer - both jaws. I spoke with Dr. Bui in Santa Clara.

Good-luck boatsink!

boatsink
Posts: 98
Joined: Sat May 23, 2009 11:56 am
Location: Bay Area, California

#22 Post by boatsink »

Awesome Attackred! Will he be your primary surgeon and assistant Dr. Desai? Glad to hear you have your surgery projected for the summer.

What was your impression of Dr. Bui? My ortho met with both surgeons for lunch. I asked my ortho what was his opinion on the surgeons. The only thing he could tell me was that they are qualified. But, my ortho doesn't have much experience with the new department at Santa Clara. He said he will keep me updated if he hears anything bad. :shock:

attackred
Posts: 18
Joined: Wed Sep 09, 2009 9:15 am

#23 Post by attackred »

Hi Boatsink,

Since I haven't "officially" booked a date - I am not sure of the details yet. They won't let me schedule for another 3 months (near ready). I'm hoping to have this surgery in early Aug - the break between summer school and fall quarter.

Dr. Bui is very nice and seems excited to help you. He fully answered all my questions/concerns and gave a detailed reason why I'm having the jaw symptoms that I described to him. We spent a good amount of time talking and even joked around for a bit. My ortho said he has worked with them before and they were very good.

Overall, I'm glad I made the move to Kaiser. Compared to my last surgeon, the difference was night and day.

dvdrdiscs
Posts: 97
Joined: Sun Dec 13, 2009 12:18 am

#24 Post by dvdrdiscs »

Hi attack,

I am currently around the same step as you and I also have Kaiser. I just got a referral from my PCP to see a maxillofacial surgeon next Thursday. I have my records all ready from my ortho. My ortho specifically works with this surgeon so I think they have a good working relationship. I'm wondering what else is there to wait for once you have your consultation? I'm really anxious to get the surgery done but I was told my ortho office that a consultation doesn't mean I should expect surgery soon. I'm not sure what else the ortho has to do to prepare me for the surgery. The last time I was at the ortho, she didn't even check my teeth. So what is this long process that is left between the consultation with the surgeon and the day of surgery?

LAJaw
Posts: 83
Joined: Wed Dec 16, 2009 7:17 pm
Location: Southern California

#25 Post by LAJaw »

I just had my initial consultation with a Kaiser surgeon. I was required to bring a set of molds, x-rays, and a letter from my orthodontist. The surgeon took one quick look at me, fiddled around with my molds, and said "Yep, you need surgery." Then he took some time to write a response letter to my ortho and answer some of my questions.

As far as I can tell, that's all it takes to get approved for the surgery. Now time to get braced!

attackred
Posts: 18
Joined: Wed Sep 09, 2009 9:15 am

#26 Post by attackred »

Hi dvdrdiscs,

I'm not exactly sure since I am not at that phase yet. The initial meeting was pretty much the same as LAJaw's. I just know the next meeting is when we set a date and then I need to attend the course regarding the surgery. If the surgeon says you need it then you're getting it!

I'll let my ortho and the surgeon work out the logistics.

almost50
Posts: 175
Joined: Tue Oct 07, 2008 3:17 am
Location: Bay Area California

#27 Post by almost50 »

I saw the surgeon at Kaiser to get approved before I even got braces. I didn't want to go down a path and be stuck not being covered cause I couldn't pay for it otherwise. My surgeon approved it and then I had my braces put on. I was in braces for about 8 months when my orthodontist said I should call Kaiser and schedule the surgery. The wait time for surgery at that point was about 6 months (the orthodontist was aware there is about that much lead time). I next saw my surgeon about a week before my surgery.

dvdrdiscs
Posts: 97
Joined: Sun Dec 13, 2009 12:18 am

#28 Post by dvdrdiscs »

LAJaw wrote:I just had my initial consultation with a Kaiser surgeon. I was required to bring a set of molds, x-rays, and a letter from my orthodontist. The surgeon took one quick look at me, fiddled around with my molds, and said "Yep, you need surgery." Then he took some time to write a response letter to my ortho and answer some of my questions.

As far as I can tell, that's all it takes to get approved for the surgery. Now time to get braced!

it seems like a lot of people get approveal from a surgeon before getting braces. im actually almost two years in now with braces and only am going to see the surgeon for a consultation. this seems to be the process that my ortho uses.

dvdrdiscs
Posts: 97
Joined: Sun Dec 13, 2009 12:18 am

#29 Post by dvdrdiscs »

attackred wrote:Hi dvdrdiscs,

I'm not exactly sure since I am not at that phase yet. The initial meeting was pretty much the same as LAJaw's. I just know the next meeting is when we set a date and then I need to attend the course regarding the surgery. If the surgeon says you need it then you're getting it!

I'll let my ortho and the surgeon work out the logistics.
what is this course you are talking about?

dvdrdiscs
Posts: 97
Joined: Sun Dec 13, 2009 12:18 am

#30 Post by dvdrdiscs »

almost50 wrote:I saw the surgeon at Kaiser to get approved before I even got braces. I didn't want to go down a path and be stuck not being covered cause I couldn't pay for it otherwise. My surgeon approved it and then I had my braces put on. I was in braces for about 8 months when my orthodontist said I should call Kaiser and schedule the surgery. The wait time for surgery at that point was about 6 months (the orthodontist was aware there is about that much lead time). I next saw my surgeon about a week before my surgery.
so whats happening during that 6 months? were you actually surgery ready when you went to see the surgeon for the first time? that is were you already on the stiffest wire? or did your orthodontist just anticipated the 6 month lead time and sent you there knowing your teeth were not ready yet?

the reason im asking so many questions is because i am trying to get a feel for when surgery might happen. i have things coming uup that may prohibit me from getting surgery later this year. im hoping id be ready to get it done within the next 4-5 months.

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