Did Insurance Help Pay for Your Surgery?

[kjohnt]

[quote="snapdresser"]Sirwired, my surgeon confirmed that I don't need braces. Instead she's planning to use arch bars, and the elastics can attach to those. That seems to be standard operating procedure for when there are no bite issues.[/quote]

I too believe I won't need braces, as my occlusion is good and both jaws are recessive (genetic mandible, retractive headgear maxilla, used to be class II). I visited my childhood ortho recently and he confirmed that I'm likely a candidate for arch bars, but ultimately this is up to the surgeon.

My Providence insurance specifically states orthognathic surgeries are never covered, and most insurances that cover these only do so if there is a functional issue with the bite anyway - sleep apnea can be "fixed" with a cpap. So I'll pay out of pocket. I'm still searching for an affordable surgeon with good reviews. Hoping for $20kish or less including anesthesia and hospital fees.

[snapdresser]

My Providence insurance specifically states orthognathic surgeries are never covered, and most insurances that cover these only do so if there is a functional issue with the bite anyway - sleep apnea can be "fixed" with a cpap. So I'll pay out of pocket. I'm still searching for an affordable surgeon with good reviews. Hoping for $20kish or less including anesthesia and hospital fees.

BCBS covered it for me for sleep apnea. Other people have gotten it covered for that reason as well.

[cbrfoltz]

I was hoping to get my surgery in during 2015. It wasn't possible. So, going into 2016, I shopped around for insurance companies.

I found that THE most helpful approach was to speak with the Insurance Coordinator at your Oral Surgeon's office and ask him/her which insurance company is the absolute easiest to deal with, and get approval from, and which they're in network with, and if you can get it out of them as well, which hospital the Oral Surgeon uses, and if they're in network.

In my case, my husband is self-employed, so we only had 2-3 choices. The unanimous answer was Aetna. That's who we chose, and they approved everything including the genioplasty at 100% after deductible. We have one of those HSA plans that has a super-high deductible and then covers everything at 100% in network.

I've been able to speak with the RN at Aetna who is on the team that makes the all OMF surgical approvals for Aetna. So, I have it in writing and verbally in advance that the surgeon, the hospital, and the anesthesiologist are all in network. Anesthesia has been the sticking point in the past, but the way Aetna does it is if the hospital's in network, so is the anesthesiologist.

There is a lab fee for the Oral Surgeon for making the surgical stent that is not ever covered by any insurance company, and has to be paid out of pocket up front on the day of the pre-op visit.

Claire

[snapdresser]

There is a lab fee for the Oral Surgeon for making the surgical stent that is not ever covered by any insurance company, and has to be paid out of pocket up front on the day of the pre-op visit.

Claire,

I think you meant "splint"? I didn't have any additional out-of-pocket expenses from my pre-op, so I'm not entirely sure that's true. My surgical splints seemed to be included in the surgical costs or something. Or it's possible that it could have come out of the initial fee I paid to my surgeon to have my first appointment with her. That was the only thing I ever paid to my surgeon or anyone else that wasn't covered by my insurance (besides copays).

[joecinq03]

I also went the private insurance route and chose Aetna, they've been nothing but excellent so far. Pre-approved everything in a timely manner, only hang up was they approved only 1 day in the hospital but my surgeons office quickly got them to ok another when I was in. Obviously it all depends on your individual case but they deal with tons of potential jaw surgery patients and have a full knowledgeable staff to review your claims so you'll get a fair review.

[MagnoliaMama]

I just had both jaws done to correct my open bite/over bite on 3/11/16. I have a Cigna policy thru my husband's employer that covers my whole family but my surgeon of choice only participates aa an in network physician with BCBS. During open enrollment I bought an individual BCBS policy thru the marketplace with a super low deductible and a very low out of pocket max. I also kept the Cigna policy in place.

Prior to starting ortho I was told by my orthodontist that he had shown my records to the surgeon and that they both were confident that insurance would approve the surgery. I was still very uncomfortable with not knowing, even after the surgeon told me he was 99.99% sure that we'd run into no problems. Their office submitted for pre-approval about a month prior to my scheduled surgery, which made me SO anxious. On 3/9, only two days prior to surgery, I was finally told that BCBS and Cigna both approved me for all requested procedures.

I've yet to see any bills, but I feel very very fortunate that both plans approved me so quickly and without any issues or questions. I was emotionally prepared for needing to challenge a denial but I'm so glad I didn't have to. From everything I've read over the years I've spent hemming and hawing over getting this surgery I know I'm incredibly fortunate to not have had to fight for coverage.

[cbrfoltz]

I don't know. My husband doesn't either. I see my surgeon 6 days pre-op, and he makes a surgical stent that he'll have to do quite a bit of lab work with. It's not covered by insurance. My *understanding* is that the stent is placed in my mouth during surgery, and it's what keeps my occlusion/bite and TMJ where they're supposed to be. Either the stent, or something will stay in place until day 60 post-op.

[snapdresser]

Splint*. It's a splint. A stent is what they stick in blood vessels to keep them open.

[LyraM45]

Federal Employee BCBS 100% covered my lefort I and BSSO revision surgery.

[MagnoliaMama]

Federal Employee BCBS 100% covered my lefort I and BSSO revision surgery.

LyraM45! This is Dayle

Even though I haven't been on fb to chat in the group I've been following along with your blog. I cried actual tears for you when I saw your post-op bite! Welcome to the Class 1 good life, girl! I'm 4 weeks out tomorrow and loving my bite, wishing my swelling would hurry up and scram, and having a love/hate relationship with my splint. I'm so glad your story got its happy ending! Xoxo

[LyraM45]

Federal Employee BCBS 100% covered my lefort I and BSSO revision surgery.

LyraM45! This is Dayle

Even though I haven't been on fb to chat in the group I've been following along with your blog. I cried actual tears for you when I saw your post-op bite! Welcome to the Class 1 good life, girl! I'm 4 weeks out tomorrow and loving my bite, wishing my swelling would hurry up and scram, and having a love/hate relationship with my splint. I'm so glad your story got its happy ending! Xoxo

HHHEEEYYY!!!!! I have been wondering how things went with you!! You dropped off of fb at just the wrong time to follow up and see how everything went! AWESOME news that everything worked out!! Do you know when you'll get your braces off?

[MagnoliaMama]

Ashley,
That's the million dollar question, right?! I see my ortho on the 18th, immediately following my de-splinting at my surgeon's. I'm hoping he's full of good news as far as when I'll be debraced! From what I can see through the splint I'm looking spot on. Midline is on the money, my teeth swing right into the splint without any fuss, and nothing feels amiss.

I do have a focal irritation hyperplasia hanging out on my gum tissue by my lower right side molars which *could* be indicative of infected hardware. It seems unlikely since there's no swelling, no heat, no tenderness, no pus. I think that was my accidental syringe sweet-spot during the first 10 days, so I'm guessing/hoping I won't need plate removal. If no other signs of infection show up my surgeon will remove the hyperplasia with just a shot of local, right in the office. I'll shoot you a private message with my new face! I'm super pleased at where I am at the one month mark!

[zab92]

Samoorelaw -

Would you mind sharing some details on your fight with United? As a fellow law student who has been told my entire law I need this surgery (have 8 mm underbite/TMJ/neck problems) yet been denied once already by United, I can use any help I can get.

Thanks

[fullbald]

I am in Australia. Jaw surgery is for medical purpose, it can be done free of charge through Medicare (National Health System), however the wait list can be few years. I am going private, roughly its going to cost me $30,000 AUD for Surgery, Orthodontics, Anesthesia and hospital cost.

[Pequod]

In my case I had a 6mm open bite and 2mm was covered, so no issues getting approval.