Insurance Concerns

[KaylaChristine]

The claim for the surgery just disappeared from my claim list. I have no idea what that means. It never finished processing or anything. I'm trying to sit tight and be patient and wait until Wednesday to give the surgeon's office a call. I don't want to bug them before the 3 weeks is up.

[deathorglory]

:T that's...really annoying. Maybe they were submitting a test claim to verify that it was approved...? Don't worry! Wednesday is coming up soon...!!! You can do it!!!!

[KaylaChristine]

Just spoke with the surgeon's office. BCBS denied the surgery and told them to submit it to my dental insurance (even though it's a medical procedure...) and then after they deny they'll submit it to BCBS again. I'm trying to stay positive but I'm pretty discouraged and upset. Here's to another few weeks of waiting...

[sirwired]

Submit it to dental? I don't blame you for being exasperated. Even if dental insurance would cover it, (it won't), the cost of the procedure would completely blow the annual limits of any dental policy without even trying hard.

Can they not read the *bleeping!* treatment codes? In what universe does dental insurance ever cover orthognathic surgery? Dental insurance treats teeth and gums. Jawbones clearly are neither teeth nor gums. Period. Done.

[deathorglory]

Ask the medical ins for the paperwork on why they denied coverage. That way, you can send it to your surgeon and they can argue specific points to appeal the denial.

[deathorglory]

Any updates, KaylaChristine?

[KaylaChristine]

I got a letter from Delta Dental today saying they won't pay any of the surgery (of course). I imagine the surgeon's office got it today as well and that they will be submitting it to BCBS again w/Delta's denial. Hopefully I'll hear good news by the end of the month....*fingers crossed*

[KaylaChristine]

The claim for the surgery is on my BCBS account again.....I imagine I'll hear back in a week. I really don't want to have to fight them...I really hope they approve it this time.

[KaylaChristine]

The claim is no longer on my BCBS. Last time I got a letter in the mail from BCBS w/ the denial the day after I called the surgeon's office. I think I'll wait until I get a letter before I call the surgeon's office about it. I'm just so nervous.

[macve004]

Had similar numbers to you (for underbite and crossbite) -- bimax surgery, sagittal split-- all covered under BCBS. This was pre-approved before surgery, so I knew going in I wouldn't be slammed with the bill.

[KaylaChristine]

macve004 Congrats on your surgery!!

I called the surgeon's office on Monday and they said they haven't heard back from insurance yet.

I received this post card from my insurance in the mail today...I'm hoping it's a positive sign! Anyone else receive something like this when they were trying to get pre-approved?

[KaylaChristine]

I just got the call.....surgery has been APPROVED!!! My portion of the $12,035 surgeon fee is around $1,000. I'm so excited...and stressed...and nervous...but mostly excited!!! I'm so happy!

[deathorglory]

I just got the call.....surgery has been APPROVED!!! My portion of the $12,035 surgeon fee is around $1,000. I'm so excited...and stressed...and nervous...but mostly excited!!! I'm so happy!

CONGRATS!!!! Told ya not to worry

[sirwired]

Congrats! Now that you're done obsessing about the insurance coverage, you get to obsess about the surgery itself! The fun never stops!

I know that when my approval letter came in the mail, I waved it around and cheered just like I had gotten accepted into college all over again or received a job offer.

[KaylaChristine]

Thank you both!! It feels so surreal to actually have it approved.

Haha yep!! There's just so much to obsess and worry about lol.

I'll probably get my letter in the mail sometime this week. I can't wait to get it even though I already got the call lol.

I just called to make an appointment w/the orthodontist. I'll be getting braces (I'm assuming only bottom ones for now) on October 14th. I was hoping to get them on a little sooner than that, but oh well. I'm really busy with work right now so I wouldn't have been able to take off until October 8th anyway so what's one more week of waiting. I'm going to be SO broke the next 2+ years paying for those darn things lol.