That blows....
Does anyone else know of a good dr. that provides discounts? We are willing to travel to another place in the US.
What are the details about the Costa Rica center? Might think more about it. This is just crazy!
working with the insurance company
Moderator: bbsadmin
Hi Masher,
Sorry I'm not in your area, but $15K sounds right for upper & lower jaw surgery in these parts. That's what my OS charged and it did not include the hospital fees or expenses. I was in the hospital only overnight but the bill is still outragous. Thankfully mine was covered by insurance because I have sleep apnea, but I still had to pay a large portion out-of-pocket.
Has your wife ever had a sleep study done? If she snores and is tired most of the time she might have sleep apnea and then your insurance may cover some or all of the expense. My OS also offers surgery in the office for people without insurance to help reduce the expense (no hospital charges), perhaps you can find an OS in your area that also offers this surgery in-office?
Another option is medical tourism and I believe some people here have gone that route. Just do a google search on "Medical Tourism" and you'll get lots of hits/information. Best of luck!
Sorry I'm not in your area, but $15K sounds right for upper & lower jaw surgery in these parts. That's what my OS charged and it did not include the hospital fees or expenses. I was in the hospital only overnight but the bill is still outragous. Thankfully mine was covered by insurance because I have sleep apnea, but I still had to pay a large portion out-of-pocket.
Has your wife ever had a sleep study done? If she snores and is tired most of the time she might have sleep apnea and then your insurance may cover some or all of the expense. My OS also offers surgery in the office for people without insurance to help reduce the expense (no hospital charges), perhaps you can find an OS in your area that also offers this surgery in-office?
Another option is medical tourism and I believe some people here have gone that route. Just do a google search on "Medical Tourism" and you'll get lots of hits/information. Best of luck!
~ Hedybleu
Well, I haven't given up the fight!
Today I talked with my senior VP at my company about how horrible it is and presented lots of facts to him, including that our competitor pays for the surgery. He knows they would hire me in a heartbeat. I also pointed out that if I was in the California office, I could switch to Kaiser and have the surgery paid for.
I'm not sure it will work but they know that they see my role as critical so I'm playing that card. If they fix it, I hope they fix it for everyone not just me (We are self insured, so that gives them flexibility) I met someone in my local office who is in the same situation I'm thinking of seeing how many people across our company are in the same situation to prove a point if they don't fix it. I know if I leave, a few key people will follow me.
Today I talked with my senior VP at my company about how horrible it is and presented lots of facts to him, including that our competitor pays for the surgery. He knows they would hire me in a heartbeat. I also pointed out that if I was in the California office, I could switch to Kaiser and have the surgery paid for.
I'm not sure it will work but they know that they see my role as critical so I'm playing that card. If they fix it, I hope they fix it for everyone not just me (We are self insured, so that gives them flexibility) I met someone in my local office who is in the same situation I'm thinking of seeing how many people across our company are in the same situation to prove a point if they don't fix it. I know if I leave, a few key people will follow me.
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gradgrill2
- Posts: 3
- Joined: Sat Aug 30, 2008 9:16 pm
Hi, Masher -
I'm sorry about your tales of woe. 5 months before getting my braces on, I was diagnosed with sleep apnea. They should be aboe to tell through her Ceph X-rays whether her airway is narrowed due to her jaw position. My insurance company will cover the surgery since I was unable to tolerate the CPAP machine. If she hasn't already, have your wife discuss any sleep problems with her PCP so she can get a sleep study. Any score over 5.0 is considered apnea. They will initially prescribe CPAP - which is difficult to get used to. If she doesn't tolerate it, surgery is the next best therapy. At its worst, sleep apnea is life threatening and surgery should be covered by insurance.
I live in Houston - not Austin. But, after all you've gone through, I'm sure the drive isn't a big deal. The recommended surgeons are Dr. Terry Taylor (Methodist Hospital) and Dr Busiady at UT-Houston. They are the best surgeons in Texas.
Good Luck!
I'm sorry about your tales of woe. 5 months before getting my braces on, I was diagnosed with sleep apnea. They should be aboe to tell through her Ceph X-rays whether her airway is narrowed due to her jaw position. My insurance company will cover the surgery since I was unable to tolerate the CPAP machine. If she hasn't already, have your wife discuss any sleep problems with her PCP so she can get a sleep study. Any score over 5.0 is considered apnea. They will initially prescribe CPAP - which is difficult to get used to. If she doesn't tolerate it, surgery is the next best therapy. At its worst, sleep apnea is life threatening and surgery should be covered by insurance.
I live in Houston - not Austin. But, after all you've gone through, I'm sure the drive isn't a big deal. The recommended surgeons are Dr. Terry Taylor (Methodist Hospital) and Dr Busiady at UT-Houston. They are the best surgeons in Texas.
Good Luck!
Re: working with the insurance company
Just stumbled on this thread and wanted to comment on the Costa Rica option. It is a good option worth considering if money is a factor. There is one surgeon there who is good and he trained under Dr Wolford. He's not the most experienced in the world but he's done enough to know what he's doing. I know someone who had surgery there and the result was excellent. The main drawbacks have to do with travel. Recovering away from home, exposure to new bacteria, and limited opportunities for followup care are problems. They're not insurmountable though if you need to save money.
Re: working with the insurance company
Another alternative for self-pay is having a surgeon that works for a Dental School do the work. I had mine done by a professor at UNC-CH and even his "rack" rates for his fees were not nearly so large. (Hospital fees were still their normal high selves.) The Dental School does so much of the orthognathic in my area that only a single other surgeon in the entire metro area even bothers getting listed with health insurance companies.
For some cases (i.e. LeFort-only), some surgeons may be willing to do it outpatient, which obviously saves beaucoup bucks.
For some cases (i.e. LeFort-only), some surgeons may be willing to do it outpatient, which obviously saves beaucoup bucks.
Re: working with the insurance company
There was a coding error at first after I had my pre-aproved SARPE so the initial paperwork we got from the insurance co stated that the hospital bill was denied, and just the hospital bill was $28,000. Yes, that is the correct amount of zeros.
My surgeon's fee was something like $4,000. The anesthesiologist also billed separately but I don't remember what his fee was.
After the coding error was fixed, I think the "adjusted" fee was something like $5,000 and I had a 30% copay. After reaching my yearly out-of-pocket maximum, I think ended up paying around $1,000 for the hospital fee.
If you know ahead of time that insurance won't cover it, you can often work with the hospital to lower that fee. If you are uninsured, or let the hospital know that your insurance won't cover your hospital stay, they will likely give you a reduced rate option. My surgeon has a deal with the local hospital to substantially lower the hospital's fee to around $10,000 for folks who aren't approved for orthognathic surgery. I know hospitals will often work out payment plans too, so you might not have to pay that huge bill in one chunk. My surgeon himself has said he would offer a 15% discount on his normal fee for people who aren't approved.
I guess the bottom line is, talk to your surgeon, and talk to the financial people at the hospital. If you're stuck with a specific exclusion, you still might be able to afford the surgery.
My surgeon's fee was something like $4,000. The anesthesiologist also billed separately but I don't remember what his fee was.
After the coding error was fixed, I think the "adjusted" fee was something like $5,000 and I had a 30% copay. After reaching my yearly out-of-pocket maximum, I think ended up paying around $1,000 for the hospital fee.
If you know ahead of time that insurance won't cover it, you can often work with the hospital to lower that fee. If you are uninsured, or let the hospital know that your insurance won't cover your hospital stay, they will likely give you a reduced rate option. My surgeon has a deal with the local hospital to substantially lower the hospital's fee to around $10,000 for folks who aren't approved for orthognathic surgery. I know hospitals will often work out payment plans too, so you might not have to pay that huge bill in one chunk. My surgeon himself has said he would offer a 15% discount on his normal fee for people who aren't approved.
I guess the bottom line is, talk to your surgeon, and talk to the financial people at the hospital. If you're stuck with a specific exclusion, you still might be able to afford the surgery.
Treatment-
- Braces: In-Ovation L (lingual) on top, and In-Ovation R (metal) on bottom
- SARPE
- BSSO advancement
- estimated 18-22 months
- Expander installed Jan 14th 2013
- Surgery Feb 18th 2013
- Turn 26 days to 13mm. Gap between teeth maxed out at 12-13mm.
- Gap down to 7mm Apr 18
- Gap Closed Aug 6
- Expander out Sep 19
- Insurance approved, surgery scheduled for Dec 18!
Re: working with the insurance company
Agreed... hospitals know that not everybody has insurance. In addition, in most states, non-profit hospitals are required to write-off a certain amount of their care every year. In North Carolina, simply living in the state gets you an automatic 15% discount at all UNC hospitals. You get the idea...