Jaw Surgery Forums » Pre-Surgery Questions

insurance wont cover anything, What do I do now?!

(17 posts)
12

  1. Shawna
    Member

    It's the silliest thing ever. My surgeon said that they have to get prior approval from my insurance carrier before they move me on to braces. That approval is good for 90 days -well that's obviously not enough time to get your teeth/face ready for surgery. Once your face is ready for surgery, they have to resubmit to the insurance again for approval. I was told that sometimes the procedure is denied the second time around. Common sense says that is absolutely ridiculous but we're dealing with insurance companies; Common sense doesn't really apply to them.

    Posted 12 months ago #

  2. mkbannon36
    Member

    Hi MikeFoss- The risk of the insurance company approving the claim when you start the process to when you are ready for surgery and then denying are really great actually. They can change their policy at any time during this time. When I was in my mid-twenties, I jumped through all the hoops. I consulted with a surgeon and an orthodontist and they both concurred the procedure was necessary. My surgeon submitted a pre-approval claim to my insurance company at the time (Blue Cross/ Blue Sheild) and it was approved. I then paid for braces and had them put on. It took right at two years to prepare for surgery and my surgeon tried to get authorization for surgery and then Blue Cross denied the claim. We tried for months to get them to approve the surgery. Nothing worked. Mind you this was round two for braces trying to correct the horribe mess the first orthodontist did when I was in my teens. So...my second orthodontist had to reverse everything we had done for two years. Back to square one. Now I'm in my mid forties - a couple years ago a friend told me he thinks I have sleep apnea and made me promise I would have a sleep study, which I did. Low and behold I have severe sleep apnea (OSA - obstructive sleep apnea) and would stop breathing over 50 times per hour. Insurance companies now recognize sleep disorders as problematic and will typically cover procedures to correct them. I have now been in full ortho for two years this June and scheduled for double jaw surgery and genioplasty (chin) 6/6/2011 where they will extend both jaws and chin a distance of between 14-22mm. I hope this helps and answers your question Mike.

    Posted 12 months ago #

  3. glittermouth
    Member

    If you entered into a plan of treatment that was specifically designed to prep you for surgery, and it was approved, I think you have a valid case to take to the state insurance commissioner. I've read on other forums that they can often bring pressure to get your insurance company to do the right thing.

    If that didn't work, I'd try Kaiser or one of the other insurance companies suggested above. Good luck!

    Posted 12 months ago #

  4. MikeFoss
    Member

    Thanks a lot for the helpful replies. In the approval letter that I received from my insurance, it states that this claim is valid for 6 months and there would be another review made at every 6 month mark which is kind of silly. It's obviously not enough time for me to get prepared for the surgery. I talked to the surgeon's assistant, and she basically said the insurance will just update the letter's status and since they've already reviewed and approved your case, there is nothing to worry about. She also mentioned that your medical insurance does not care about how your ortho is done, who your orthodontist is, so you don't need to report to them about your orthodontic treatment.
    I'd like to hear if anybody else was in this sort of situation where there are different review dates and if it's going to cause problems with their coverage over the time!

    Posted 12 months ago #

  5. mkbannon36
    Member

    Hey Mike - I think that if your insurance approved it already, the odds are that when you are ready for surgery you will still be approved. I would try not to worry too much.

    Posted 12 months ago #

  6. chai-latte
    Member


    Posted 4 months ago #

  7. Blondek1
    Member

    Hi justjean! I was in the same situation as you! the insurance I had denied my claim then we appealed it and again they denied it. Then my doctor sent out an External Appeal thru the state, and the state decided that i medically need this surgery and forced my insurance to pay for it. Hope this helped!

    Posted 4 months ago #

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