Arnett or Gunson in Santa Barbara?

[ColoradoGirl]

Oh, and on the differing povs topic: both docs measured me before my surgery, independently of each other, and both came to exactly the same conclusion. Dr. Gunson was even laughing about it, because Dr. Arnett said something--can't remember what--that isn't necessarily routine but he thought would apply in my case, and Dr. Gunson had just written the same thing in his notes. The assistant told me the two doctors think so much alike that sometimes it's like they're the same person.

[herecticx]

Hi,

does anybody know how far i would have to book ahead to get a consult with these guys??

[snapdresser]

Well, one of the posters said he couldn't get in until the new year and it was September, so maybe ~4 months for Arnett? Why don't you call over and ask? I'm sure the person at the front desk would be happy to tell you.

[tinymandibleAZ]

For those of you you had more than one consultation (i.e., more than one surgeon), how much more expensive were Arnett and Gunson than those other guys?

[cbrfoltz]

You can call the financial person at Dr. Gunson's office, and she'll give you the specifics. They aren't in network with any insurance plans, so you are going to pay more out of pocket. A lot of times, there are very good reasons for making that decision.

[SantaBarbarian]

An update, since most of this thread is now outdated:

I had my surgery with Dr. Gunson on December 2, 2015. I initially thought Dr. Arnett would be the best, since he has more experience. That was all I knew about the two of them and I thought that that was all I needed to know. My orthodontist, Dr. Dawn Thatcher in Santa Barbara, however, provided some different insights that made me reverse my decision.

First, I was told that Dr. Gunson tends to provide the patient more time. I believe this is worth more than gold. I often feel rushed in most doctors' offices, but I've never once felt that way with Dr. Gunson (and I've seen him a LOT during post-op follow-ups). Sometimes I've had to wait to be seen quite a while, especially when emergencies pop up, but I know he's giving every patient the time they need, including me, and I'd rather have it that way than to rush us.

Second, Dr. Arnett is older, and the prime age for a surgeon is younger than you might think (I forget what my orthodontist said, but I think it was just 30-40 years old!). Getting too old means that you can get too set in the old ways (you know, the way you've been doing it for 20+ years) and you lose touch with the latest and greatest science. Furthermore, a surgeon's skill is maintained by continually practicing (i.e., operating), not by teaching. I recall reading one study about ER heart doctors that showed a statistically significant difference in success (which means life or death) after being away for just two days. Fortunately, while segmented double jaw surgery is a huge surgery, it is not life-threatening like emergency heart surgery....!

For all of these reasons, Dr. Gunson was the clear choice in my mind and I did not even consider consulting with Dr. Arnett. I'm confident he's an excellent surgeon and based on other posts here it's clear that he and Dr. Gunson are very similar, but Dr. G was the clear way to go for me. Also, I think Dr. G may be differing himself slightly at this point, as he once commented during pre-surgical workup that he added an extra layer of double-checking on top of Dr. Arnett's pre-op surgical planning procedures to double-check that everything will happen the way it should when the surgery is performed. He's also commented that Dr. Arnett will intentionally not perform certain examinations because the first two weeks after surgery are really wacky (so much inflamation!) and the surgeon needs to trust that the pre-op work will ensure a good outcome when things settle down, but this means that some things (e.g., mild fungal infection) can go unchecked longer. Both surgeons have reasons for what they do, and both are working in what they believe is the best interest of their patient to avoid the potential for complications; in my non-expert experience, I personally just side with the approach Dr. Gunson has taken.

Dr. Gunson now has 15+ years of experience performing surgery and, from what I've seen, I think he is now training the next partner(s) in the practice (but this is speculation on my part based on educated inferences). As such, I think Dr. Arnett will still assist occasionally still but I think (and do not quote me) that this is happening fairly rarely now.

I realize this was more negative towards Dr. Arnett than I'd initially intended, but for all the reasons above, the choice for me was, and still is, crystal clear.

[snapdresser]

I realize this was more negative towards Dr. Arnett than I'd initially intended, but for all the reasons above, the choice for me was, and still is, crystal clear.

You have no regrets and would still recommend Dr. Gunson to others, even though he severed your nerve?

[SantaBarbarian]

Hi Snapdresser,

Yes, I have no regrets and would do it all over again. Of course, I'd prefer that the nerve not be severed... but it was a freak accident. Did you get that detail from my blog post? I don't think I mentioned it in this thread.

For everyone's understanding: During the surgery, Dr. Gunson fractured the lower left side of my jaw. Everything with the nerve was fine and it fractured as expected. He then proceeded to fracture the right side of my jaw, and it fractured as desired as well... with the exception that when he went to check the nerve on my left side, it had been severed during the fracturing of the right side. Dr. Gunson reported that during his 15 years of surgeries covering thousands of patients, this had only happened twice before. The possibility of severing a nerve was always stated as a risk, mine just happened to be severed in a very unusual and unlikely way. It was even more unlikely because the nerve running through my lower jaw was lower than most patients's nerves, which in this case was a good thing making it less likely to be severed. Due to my very thin maxilla, we were expecting complications there, but that turned out not to be a major issue during the surgery. So we metaphorically dodged the fast-moving car coming from the left that should have hit us and instead got hit by the bicyclist that turned the corner and should not have been there (my metaphor, not Dr. G's).

I just posted a longer reply just minutes ago to another person in another post asking about the outcome of my surgery. It hands-down is a life-changing surgery and for that reason I would do it all over again (and I said this in my blog), even if it meant that I never regained feeling in the left side of my chin.

The good news is that I AM regaining feeling in the left side of my chin. Instead of 100% numbness with ZERO feeling whatsoever, it's like someone molded some really thick rubber to my chin. I can feel that solid objects (eg, the edge of a pen) are pushing against it and I can feel my muscles contracting/squishing when I pucker my lips, for example. And this is after only 4 months - nerves will continue to heal for over a year (though I will be very lucky and grateful if I get more than 50% sensation, and I'm already very lucky and grateful to have any sensation).

You can find my recent post with more recovery details by googling "arnett gunson cost" (it got a little off-topic but I wanted to respond to the person's question about my recovery).

You can find my blog with a lot of initial recovery details (first month, anyway; I forget when I stopped due to life and time constraints; I still intend to continue it someday) by googling "Chris's Jaw Surgery 2015."

[SantaBarbarian]

[quote="tinymandibleAZ"]For those of you you had more than one consultation (i.e., more than one surgeon), how much more expensive were Arnett and Gunson than those other guys?[/quote]

Hi TinyMandibleAZ,

I had consultations with Dr. Gunson described in my April 5th post above as well as several other providers.
UCLA and Stanford: both were in-network so basically it would have cost my my maximum annual out of pocket ($2,500). UCLA surgeon did probably 50 of these surgeries per year (so regularly, but was not exclusively performing this surgery). Stanford surgeon exclusively performed this type of orthognathic surgery and I loved him at first but in the end there were some major issues - major enough that I ended up choosing an out-of-network surgeon that charged my entire annual take-home pay (I did not make that switch lightly!). Dr. Arnett and Gunson's sticker prices are incredibly shocking, but when you begin to understand how much follow-up care they provide free of charge, it's actually a bargain. I think the value of the services (as determined by Medicare, which everyone knows is TERRIBLE!) is 50% MORE than what Dr. Gunson charged. Getting insurance to actually pay for it, however, is a difference matter, but I have been successful in getting them to pay almost everything (we're currently fighting over $7k instead of $45k)!

Another Option could have been Dr. Movahead (or Movahed?), but he is in another state (Colorado?). I never met with him but I expect he would have been in the $30,000-$40,000 range, but it's also unclear how much follow-up would have been provided, and then I'd also have to pay for plane flights and hotels, etc., and insurance DEFINITELY doesn't pay for that stuff, either.

I also met with an out-of-network surgeon at UCLA. He did not provide a specific fee but I think he ballparked it in the same range as Dr. Movahed.

[Bride2B]

Hi SantaBarbarian, today I had my first consult with Dr. Gunson and I was just about ready to sign away my soul. Until I was told how much it would cost. Being completely new at this, I was floored. I thought my insurance would cover most of it and then I was informed he was out KD network. Is there any way that I could email you and figure out how you worked out this miracle??

[Bride2B]

[quote="SantaBarbarian"][quote="tinymandibleAZ"]For those of you you had more than one consultation (i.e., more than one surgeon), how much more expensive were Arnett and Gunson than those other guys?[/quote]

Hi TinyMandibleAZ,

I had consultations with Dr. Gunson described in my April 5th post above as well as several other providers.
UCLA and Stanford: both were in-network so basically it would have cost my my maximum annual out of pocket ($2,500). UCLA surgeon did probably 50 of these surgeries per year (so regularly, but was not exclusively performing this surgery). Stanford surgeon exclusively performed this type of orthognathic surgery and I loved him at first but in the end there were some major issues - major enough that I ended up choosing an out-of-network surgeon that charged my entire annual take-home pay (I did not make that switch lightly!). Dr. Arnett and Gunson's sticker prices are incredibly shocking, but when you begin to understand how much follow-up care they provide free of charge, it's actually a bargain. I think the value of the services (as determined by Medicare, which everyone knows is TERRIBLE!) is 50% MORE than what Dr. Gunson charged. Getting insurance to actually pay for it, however, is a difference matter, but I have been successful in getting them to pay almost everything (we're currently fighting over $7k instead of $45k)!

Another Option could have been Dr. Movahead (or Movahed?), but he is in another state (Colorado?). I never met with him but I expect he would have been in the $30,000-$40,000 range, but it's also unclear how much follow-up would have been provided, and then I'd also have to pay for plane flights and hotels, etc., and insurance DEFINITELY doesn't pay for that stuff, either.

I also met with an out-of-network surgeon at UCLA. He did not provide a specific fee but I think he ballparked it in the same range as Dr. Movahed.[/quote]


Also, to talk about the surgeons you consulted with.

[SantaBarbarian]

Hi Bride2Be,

A note up front: I recommend printing this out, highlighting the action items I recommend, and then making a list and going through them systematically. Also note that the last part is split onto the next post. There's a lot of info here....

If you still want to discuss, I think we can work something out; maybe even a phone call? Not sure how to share our personal info without posting it all over the internet though...

Surgery approval and payment was a two-year nightmare. It took me a year to get my insurance company (Cigna - I hate them with a deep burning passion) them to authorize the surgery because they kept saying I didn't meet their criteria. I reviewed their criteria, learned the jargon, traveled to UCLA to have a specific scan done (that they required), etc. Dr. Gunson could have done this scan for me, but I wasn't working with him at the time I needed it done, and since you've already had the consult with him, you don't need to worry about getting another scan at this point. Cigna stated they had reviewed every page of the materials submitted in detail, and there was one page that contained evidence of sleep apnea, yet they said I didn't have a functional disorder (e.g., no apnea) and therefore was not approved. I had to reach out to my company's HR representatives and work with them for several months before they looked into the details and told Cigna "it looks like he has apnea to us - why does he not qualify?" A couple days after that, they came back and said they had NEVER reviewed that particular sleep study result, even though (1) they'd said they'd reviewed every page of every sleep study in detail for months, and (2) I had already been through the initial application, doctor-to-doctor consultation, an informal review of the initial application, and a formal appeal. How they did not see it during all this time is beyond me.

Part of the problem is that I would wake very quickly after I would stop breathing due to an obstruction. The definition of "apnea" is that you stop breathing for at least 10 seconds. During my first three sleep studies (two in-lab in Santa Barbara, one at home), I was so uncomfortable (particularly during the in-lab studies) that I could not sleep through not breathing for 10 seconds, so no apneas were recorded. The at-home showed an apnea-hypopnea index (AHI) of 5, the bare minimum to be diagnosed with obstructive sleep apnea (OSA).

Even worse, I never would have gotten to that point above above (multiple back-and-forths with Cigna over the course of several months after so many reviews/appeals, etc.) if my HR had not provided a specific contact at Cigna for me to work with to resolve the ongoing issues. If my company had not done that, I would have been forced to use Cigna's general customer service people. After months of trying to work with them first, it became clear how their game worked. Their game has changed slightly since then, but at the time, the first person to answer (who could not provide any real info about how the company works because the first layer has no clue, by design) would say that you could not speak to a supervisor (who MIGHT know something about how to proceed, usually about 1 out of 15-20 supervisors were at least moderately helpful). Instead, the would say that the supervisor would have to call you back and that they would call within 2 business days. Well, two business days would come and go, and a week would come and go, and I'd call and ask why I never got a phone call. They'd say "oh, I'm sorry, that's not right. They should have called you. I'll put in another request. Please allow two business days for them to call you." Ad infinum!

More recently, I've had better luck - Cigna base representatives will put you through to a supervisor, at least. However, there's no guarantee the supervisor will know anything. Just last a month ago, I asked how to submit a form and the supervisor did not know. She put me on hold to inquire and then came back with a different phone number, which turned out to be to an affiliated company that handles something completely unrelated. I called back and the second supervisor told me to fill out a specific form. Looking at the form, it seemed like it had to go through my local court system. I asked about every field in the form for 20 minutes because I was skeptical, and she said to disregard half of it. I submitted it and waited a week for someone to contact me, who then asked some basic questions (that were answered in the form - she clearly didn't read what I wrote) and got back to me a week later saying that the form did indeed have to get a court order.


I digress.....

So I had one last appeal, went up to Standford for my sleep study to see if I could get a true positive result, and it worked. As the entity that has led sleep apnea research for decades, they know how to do it in a way that allowed me to actually sleep while connected to so many electrodes, and the results showed I had an AHI of 25 average, 45 when on my back = SEVERE sleep apnea. I had no trouble getting approval at that point, after a year of "working with" Cigna.

I then worked with a Stanford surgeon for 9 months, was ready to have my surgery with him, things went haywire (in my opinion, due to his poor communication during a critical pre-op period when the splint to hold my jaw in place was not produced in time - another long story). I then discontinued working with the Stanford surgeon and switched to Dr. Gunson despite the shocking sticker price.

After the surgery, it took me nearly a year to get them to pay for everything they were supposed to pay for. So, 1 year of fighting for approval + 1 year of fighting for payment = 2 years of fighting Cigna, with access to high-level representatives that managed our company's contract. This never would have happened if I had to work with Cigna's generic customer service representatives.

Here's how I got it paid in full:

1. Take detailed notes of any and all conversations you have with your insurance provider. ALWAYS ask for a call confirmation number, record the time and date you called, and who you spoke with. When you call back in, reference the confirmation numbers of previous calls.

-----------------

2. Get "Network Adequacy" coverage ASAP, and well before the surgery, for both Dr. Gunson AND the assistant surgeon! I did not realize that the assistant surgeon did not fall under the umbrella of the main surgeon, so I had to fight after the fact to get coverage. I eventually won, but it took a long time, and it's rare that that happens.

ALSO, get pre-certification approval for the surgery for the Assistant surgeon too. I don't know how most insurance companies handle this, but I had to fight Cigna to get this covered retroactively (never a good place to be) because

Depending on your provider, this could be called "GAP coverage." Under my PPO, if there are no in-network providers within a certain radius of my home (50 miles? 75? I forget), then I can ask that they cover the costs as if the out-of-network doc is in-network. Fortunately for me, the nearest in-network orthognathic surgeon is at least 80 or 85 miles away. Amazingly, this was not a fight - they authorized it it pretty quickly, probably because it was so clear that there are no in-network providers around me. If you do have an in-network provider within your plan's radius of your home, you'll have to do more homework. Questions: Can the in-network providers actually perform the surgery in question? There are many types of orthographic surgery, and the stuff Dr. G does is very, very high level. It's possible the in-network providers near you are not that specialized/capable. If they can perform that surgery, find out how many surgeries of that type they do per year. If it's less than one/week, I'd say stay away! And write a letter, submit a form, or otherwise argue that your type of surgery requires a particularly skilled surgeon and that the in-network doctors near you do not have those skills (but Dr. G does). Hopefully Dr. G's office will be able to help you with this, but I can't speak to that since I didn't have to fight for it. If you appeal to Dr. Gunson, if necessary - he's a very caring surgeon.

If you try to get such coverage after the surgery, they will tell you that you must get it before the surgery. Someone from Dr. Gunson's office once told me not to worry about it because they could always get it retroactively. That's not true, and they don't say that anymore (not that I've heard, anyway).

CAUTION:
Under my plan, in-network has a max annual out of pocket and providers cannot bill more than the contracted amount. So the max I would pay, no matter what happens, is $2,500 (at the time back then - my plan has changed since). So, when Cigna says "congratulations, we've given Dr. G in-network coverage," you might think "Wow! I only have to pay $2,500 for surgery with Dr. Gunson?!" Thinking that would be fair, but you'd be wrong. They NEVER tell you in the letter of authorization that it is subject to the Maximum Reimbursable Cost (MRC). If you call and ask, they will cop up to it, but unless someone like me mentioned it, you'd never know that you would need to call and ask because there's no indication they wouldn't pay for everything. When you ask, what they'll tell you is that, under your plan, payment for out of network providers is ALWAYS subject to the maximum reimbursable cost. To some extent, that's fair... if you elect to go to a general practitioner that charges $5,000 for a basic office visit, when most GPs charge about $100, that's your choice and insurance shouldn't have to pay $5,000. But, they should tell you when you get network adequacy

Under my plan, the MRC is defined as 110% (i.e., 10% above) the "usual and customary rate" in the area - what the average doctor charges for those particular procedures. Seems fair, right? And they even had the gall to tell me I had a good plan, because many plans are limited to 90% (i.e., 10% less than) usual and customary! Well, upon inquiry, they will tell you that they define "usual and customary" NOT by the average fee of all doctors in the area (which would make sense, if that's how it actually worked), or even the average price a contracted in-network doctor would get (also reasonably fair, if that's how it actually worked). Instead, it's based on Medicare rates, and everyone knows that rate is terrible! Moreover, Medicare classifies Santa Barbara as "rural" even though it's one of the most expensive places in the country. So, they reimburse about the same amount Medicare would reimburse if you were having the surgery done in the middle of Kansas. (Not insulting Kansas here, it's just a fact that it's less expensive to live there!)

What Dr. Gunson's office says is that they typically allow about $10,000 of the fee. Here's how my fees initially broke down:

Total, bottom-line fees were estimated before the surgery to be about $54,000. As you know, fees change based on what was actually performed during the surgery. In the end, I needed more grafts than originally estimated, but Dr. Gunson did not need a split (which was included in the original estimate). Not having to pay for the splint more than offset the extra grafts and I got a $1,875 refund. I don't know why a splint was originally included but then ultimately not needed.

WRT insurance, Dr. Gunson's office billed for this in a few ways:
$520 for pre-op procedures (by Dr. G only), fully allowed and covered without issue.

$340 each for three follow-up scans ($1,020 total for "records" as listed on Dr. Gunson's estimate), billed to insurance after they are performed. I had to follow up with Dr. Gunson's office because they did not bill for this automatically by his office (an oversight), and I had to fight insurance to get one of them authorized because they did not bill it within 6 months of performing the procedure. I still have one of these procedures (at the 2-year mark) to perform and to be billed.

$4,375 for cheek augmentation. Pulling my jaw so far forward would have made my cheeks look sunken if not performed. In the end, my face looks great, so it was well worth it. However, there's no chance that Cigna would ever cover aesthetic issues, even if they're necessary due to an authorized medical treatment. I ate this cost.

The remainder (the bulk) was billed to Cigna as part of the surgery, split between two procedures each performed by Dr. Gunson and the assistant surgeon (four line-item fees total). Here's how they were initially processed. YOU MUST WATCH YOUR EOBS CAREFULLY.

Gunson1: charged 22,450.00, allowed 1,310.91 at first. They said he accepted a discount, which he did not. When I corrected them, they increased it to $18,036.46 (the MRC).
Gunson2: charged 14,500.00, allowed 3,028.70 at first. They said he accepted a discount, which he did not. When I corrected them, they increased it to $7,036.65 (the MRC).
Assitant 1: charged 5,612.50, allowed 1,310.91. This is not a typo - for some reason they allowed the same amount as Dr. G...).
Assistant 2: charged 3,625.00, initially allowed $0(!) due to failure to get pre-authorization, later allowed $3,028.70 (the MRC).

Assistant surgeon fees by Dr. Gunson are 25% of his fee; under Cigna, they're not supposed to be above 10 or 12 or 15% (I forget), which is also subject to the MRC, so Cigna normally would only pay a very tiny fraction of the Assistant surgeon's fees.

I did, eventually, get them to cover 100% of those 4 procedures above. This was another big fight, which began before the surgery and continued for nine months after. I'll explain below, in part 3 (see next post).

By the way, each time they re-processed the fee after allowing an extra additional amount (MANY fights during this process that incrementally increased the allowed amount), they consistently paid it as if he did not have network adequacy. Meaning every time they agreed to allow an additional, higher amount, they wouldn't pay that full higher amount because their first attempt to process it was incorrect. I'm told that they must do it this way and the system does not allow them to go straight to the end point and pay what they are supposed to pay. Seems like an admission of guilt to me that they've designed the system to screw over patients and delay payment.

-------------------

[SantaBarbarian]

PART 3, CONTINUING THE PREVIOUS POST:

About 4-6 weeks before my surgery, it dawned on me: Dr. Gunson's fees are gigantic because they are all-inclusive, but Cigna only pays for fees as they are performed, and there must be a specific line-item cost associated with each fee. I called Cigna and explained this, they said they could do nothing. I asked Dr. Gunson and he said he could do nothing: since there is no fee for my post-op care, he cannot provide a statement saying that I've paid a specific amount for it (even though I've paid for it all up-front).

I had an idea: ask Dr. Gunson to make an exception and sign a form stating that he provide X, Y, and Z procedures on each date I saw him post-op, and with a statement that all fees were paid in full as part of the surgery. Then, ask Cigna to make an exception and pay me just the MRC for these procedures. The MRC for each office visit was $110-$300 depending on how long the office visit lasted, and even more when scans or photos were taken. It also turns out I was a very special case that required a LOT more than his standard amount of follow-up care (no real way to predict that in advance of the surgery). Point is, the standard patient has probably 20 office visits over two years, plus scans, etc., and I've probably had close over 60 during my first year post-op, plus the scans. Add all that up, and you'll soon realize that the value of the post-op care is about equal to, or exceeds, the value of the surgery itself (or in my case, massively exceeds the value of the surgery itself).

Dr. Gunson agreed to sign such a statement, but Cigna balked and said they could not make such an exception. I reached out to the head of my HR department who agreed that there was a lot of value in the post-op care and saw the dilemma. He agreed to ask Cigna to make this exception, and said the next day that they had done so. This particular conversation was done over the phone, and one week earlier the head of my HR asked me to "trust him." Unfortunately, he is not a detailed person, so while I don't think he intentionally tried to screw me over, the fact is when I went to submit my forms post-op that Dr. Gunson had signed, Cigna came back to me and said that they had never made such an exception. My hopes were dashed.

I immediately reached out to the head of my HR again and he agreed that he remembered we had some kind of conversataion about it, but he couldn't remember the details. What I think happened is that he probably asked "will you pay the MRC for services provided?", which of course is "yes." That is NOT the question, the question was "Will you pay the MRC for services provided even though there is no line-item cost associated with them?"

So, major fight ensued that put me in a very difficult position, asking the head of HR on my company to correct a situation that frankly he created by not being detail-oriented that would, when corrected, cost the company thousands of dollars. He did eventually step in and say that Cigna should pay something for the post-op care, they just couldn't figure out how to determine appropriate fees. For some reason, they refused to just use the MRC. Eventually, they came back and said they would pay the fees in full, and I was very happy. Within a few weeks, they produced new EOBs that did just this (after an initial incorrect EOB as noted above)... for Dr. Gunson only. They refused to pay the assistant surgeon's fees in full, pretending like she was her on self-employed person and that she was not part of Dr. Gunson's office (although she is part of Dr. G's fees).

I argued for several months that Dr. Gunson's fee is all-inclusive and how it's broken down as a line-item is irrelevant. They refused to budge for a LONG time. Yet, because of my dogged persistence and their continual errors along the way, they finally agreed 9 months after the surgery to pay the assistant surgeon's fees in full.


-----
In the end, of the ~$53,000 or $54,000 in fees, and thanks to having already met my in-network max annual out of pocket by the time I had my surgery in 2015, I only paid:
- a few thousand for the cosmetic stuff (see above)
-$340 (paid by me up front), which was applied to my 2016 deductible (since the scan was performed in 2016 and billed as its own line item at that time).
-am waiting for another scan in 2017, at which point Dr. Gunson's office will submit for the final final $340 line-item bill. Depending on how much has already been applied to my deductible in 2017, I might get some or all of that final $340 that I paid in 2015 back yet.

I hope this was helpful!

[SantaBarbarian]

Summary:

-Take detailed notes, record times, names, call reference numbers of all conversations with your insurance company.
-Get network adequacy and pre-authorization for the surgery for both Dr. Gunson and the Assistant surgeon well ahead of time. Make sure the network adequacy/GAP coverage includes pre-op AND post-op care in addition to the surgery itself. Cigna would only allow a blanket authorization to go for 1 year (vice the 2 years of post-op care that Dr. G requires), at which point I had to renew it. Be sure to renew it ahead of time - for some reason, it's much easier to renew authorization than it is to get new authorization after it's expired.
-Talk to your insurance company about how to get payment for the post-op care. If they balk, reach out to your HR department. If you are on an individual plan, God help you, because you'll probably be stuck with the general customer service. You may have to get creative (e.g., enlist the support of your state and/or federal representatives, a lawyer friend if you are so lucky, news outlet [there's some journalists that are dedicated to covering the ridiculousness of insurance companies])....
-Get any offer to pay for post-op care in writing ahead of time.
-Use the mistakes of the insurance company against them. After all, this is your time and your money they are wasting.
-Scrutinize every EOB
-Make sure Dr. Gunson's office submits the claims for the post-op scans.
-BE PERSISTENT


GOOD LUCK!!!

[Nochokin]

[quote=SantaBarbarian post_id=477844 time=1459895541 user_id=26854]
An update, since most of this thread is now outdated:

I had my surgery with Dr. Gunson on December 2, 2015. I initially thought Dr. Arnett would be the best, since he has more experience. That was all I knew about the two of them and I thought that that was all I needed to know. My orthodontist, Dr. Dawn Thatcher in Santa Barbara, however, provided some different insights that made me reverse my decision.

First, I was told that Dr. Gunson tends to provide the patient more time. I believe this is worth more than gold. I often feel rushed in most doctors' offices, but I've never once felt that way with Dr. Gunson (and I've seen him a LOT during post-op follow-ups). Sometimes I've had to wait to be seen quite a while, especially when emergencies pop up, but I know he's giving every patient the time they need, including me, and I'd rather have it that way than to rush us.

Second, Dr. Arnett is older, and the prime age for a surgeon is younger than you might think (I forget what my orthodontist said, but I think it was just 30-40 years old!). Getting too old means that you can get too set in the old ways (you know, the way you've been doing it for 20+ years) and you lose touch with the latest and greatest science. Furthermore, a surgeon's skill is maintained by continually practicing (i.e., operating), not by teaching. I recall reading one study about ER heart doctors that showed a statistically significant difference in success (which means life or death) after being away for just two days. Fortunately, while segmented double jaw surgery is a huge surgery, it is not life-threatening like emergency heart surgery....!

For all of these reasons, Dr. Gunson was the clear choice in my mind and I did not even consider consulting with Dr. Arnett. I'm confident he's an excellent surgeon and based on other posts here it's clear that he and Dr. Gunson are very similar, but Dr. G was the clear way to go for me. Also, I think Dr. G may be differing himself slightly at this point, as he once commented during pre-surgical workup that he added an extra layer of double-checking on top of Dr. Arnett's pre-op surgical planning procedures to double-check that everything will happen the way it should when the surgery is performed. He's also commented that Dr. Arnett will intentionally not perform certain examinations because the first two weeks after surgery are really wacky (so much inflamation!) and the surgeon needs to trust that the pre-op work will ensure a good outcome when things settle down, but this means that some things (e.g., mild fungal infection) can go unchecked longer. Both surgeons have reasons for what they do, and both are working in what they believe is the best interest of their patient to avoid the potential for complications; in my non-expert experience, I personally just side with the approach Dr. Gunson has taken.

Dr. Gunson now has 15+ years of experience performing surgery and, from what I've seen, I think he is now training the next partner(s) in the practice (but this is speculation on my part based on educated inferences). As such, I think Dr. Arnett will still assist occasionally still but I think (and do not quote me) that this is happening fairly rarely now.

I realize this was more negative towards Dr. Arnett than I'd initially intended, but for all the reasons above, the choice for me was, and still is, crystal clear.
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