insurance denied coverage due to age

[Jaimietez]

I found out today my surgery was denied due to being over the age of 19. I was told by the surgeons office that there is no appealing it. I'm very frustrated! Has this happened to anyone? Any advice? There seems like there has to be something I can do.
The only good news is, it looks like BCBS will pay for the hospital part of it, if I pay for the surgeon part.
Thanks, Jaimie

[BracedSurgeryStudent]

I had blue cross and it paid for all but $3,000. But I didn't end up getting the surgery because my school switched plans on me. But thats what blue cross and the surgeons office told me. I was going to do it anyway

[keeponsmiling]

I'm so sorry to hear that Jaimie. I'm in the UK so am clueless when it comes to medical insurance, but I really hope you're able to sort something out.

[Jaimietez]

Thank you.

[crooked rory]

Is it denied because you are too young or too old? I had thought headgear and related stuff could do most of what surgery could for bite in younger patients, and surgery was mainly required in older ones.

[Jaimietez]

My insurance excludes this surgery for people over the age of 19. I'm 38.

[sirwired]

Well, look on the bright side... for many surgeries, the hospital bill is the lion's share of the total charge. Out of the $15k estimate for my eventual surgery, only about $4k of that goes towards the surgeon's office.

Yeah, the surgeon's bill is going to hurt, but not nearly as much as that hospital bill would.

[MrNovember]

my surgeon fees were around 4,000 as well. how much are you required to pay out of pocket Jamie?

[Jaimietez]

Thanks for your imput everyone! I don't know yet how much the surgeon's going to charge for the surgery. I talked with someone at the office last week, when I found out about the surgery being excluded for coverage. She said she would ask the surgeon how much he would charge me, and told me to find out if the hospital part would be covered, which I did. They (BCBS) said they would not cover the hospital because the surgery is not covered. After feeling totally devistated, I read on here that some people who also needed a septoplasty got insurance to cover the hospital part after all, and paid the surgeon out of pocket for the orthognathic surgery. Well I did get approved for a septoplasty. Sooo, I am going to call insurance tomorrow and make sure they will cover the hospital bill for a septoplasty, and give the surgeon office a call again to see what we can do.
This is all so very frustrating! I hope it will work out. I would be heart broken if I can't finish this process after thinking I was finally going to fix my open bite and have a beautiful smile for the first time in my life. And the idea of biting into a burger or fajita without making a mess would be awesome!
Jaimie

[streo]

What state do you live in Jamie?

[Jaimietez]

Texas

[BracedSurgeryStudent]

My insurance excludes this surgery for people over the age of 19. I'm 38.

Oh wow that seems wrong. It's usually patients that are older that get surgery, and the younger ones that get the herbst appliance and headgear. Although nowadays you can try the herbst on adults, my ortho has a high successrate with it, mostly because all her patients are too freaked to have surgery. I went thru with the surgery, or at least I went as far as the consults until one of the surgeons said she really doesnt want to risk my jaw over a measly 3mm that braces could probably msot definatly fix. Well it's mostly my deep bite that makes it look worse than it really is.

[streo]

Texas

My oral surgeon told me that Texas is one out of two states that consistently denies coverage (I forget the other state - I want to say Tennessee, but don't quote me on that one).

[Summertimeolive]

Hi Jaime!! ahhhhhhhhh your frustration with BCBS they are POOP !!

I am under BCBS and right now Im hearing lots of crap stories about them- about how they estimate the surgery to be 2500 and thats the max they'll pay if your in network.... oh wow if they wont cover the surgery they wont cover the hospital bill YIKES!!! Please update me on the status of your surgery and coverage I hope you can get more covered! Im 26 as well and I worry they'll pull this crap with me... let me know and best of luck with your appeals !

[Jaimietez]

I talked to someone yesterday at BCBS and asked about getting the hospital bill covered since the septoplasty is approved. The person told me it depends on how the hospital bills insurance. In other words they can't tell me either way ahead of time. In the mean time I am waiting to hear if my surgeon would be comfortable doing the surgery (le fort 1, septoplasty, and maybe genio) in a surgery center in order to cut costs. We'll see what happens. I will update when I hear more. Thanks for all the support.
Jaimie