Jaw Surgery Forums » Pre-Surgery Questions

What should I do??

(17 posts)
  • Started 1 year ago by ashlea_hinkle
  • Latest reply from OpenBite
12

  1. ashlea_hinkle
    Member

    Hi everyone my name is Ashlea and I had planned on having jaw surgery this summer. I had braces put on 6 months ago, Ive taken the x rays, talk to different doctors,everything I needed to do to prepare for this surgery and now Im completely ready!Well...My surgeon assured me that my insurance( Blue Cross) would get accepted, he said he gets 90% of his clients approved. So I pick out a date (June 7th) and when we finally got our letter back from the insurance company they denied it! I know the whole insurance thing can be tricky but I had a good feeling that I would have no problem. My insurance said that there was a restriction on my case, stated if your over 19 they wont pay for it! I just turned 20 November :( Well long story short, I ask my doctor if he can do anything about this and he said no since it is a "restriction". Now were looking at 28,000$ out of pocket. We tried to get a loan even and it would be 700$ just about, for 5 years! Im a full time college student and I dont have that kind of money! I really have no idea what do to!? I feel like Im sitting here wasting time and I have no other options but to take off the braces and cancel the whole thing! But I really dont want to do that! I feel like Ive came so far I would had to throw everything down the drain! Does anyone have any ideas??

    Posted 1 year ago #

  2. jasonc
    Member

    I say look into other insurance providers or try to appeal to Blue Cross to make an exception. In my case, I could NOT get surgery until my lower jaw bones would stop growing which was not until age 22 or so. If I had surgery at 19, I would need it again years later because the bones will continue to grow! Seems ridiculous that age would restrict you from getting surgery. Jerks who makes these kinds of decisions whether or not to cover you have no clue what people like us have to go through. Write a letter showing and explaining exactly what we go through. Being blessed with perfect teeth is nice, but being blessed with a perfectly aligned jaw is even better. This is not cosmetic & anyone who writes the surgery off as not covered probably thinks that it is cosmetic. Good luck & fight for it!

    Posted 1 year ago #

  3. rachellong
    Member

    I have heard that almost all insurance companies deny the first request. Keep fighting for it. I would also try to find a more proactive doctor. It seems like he just took the 'no' and was content. If he felt you needed surgery, he should not be content to let them say no! Have him write another letter, call, or just bug them. I work with insurance companies a lot and just not letting up on them shows them that you mean business. Don't give up!!

    Posted 1 year ago #

  4. ashlea_hinkle
    Member

    Thanks guys. I have talked to several people and appealed it twice now, but still no luck and now with all my medical history no insurance companies will except me...So I'll keep fighting and update ya if anything changes.

    Posted 1 year ago #

  5. Brandon
    Site Administrator

    You're definitely being persistent Ashlea, that's great, so keep it up, and good luck!

    I'm Brandon, the creator of JawSurgeryBlog.com. I personally had upper and lower jaw surgery on October 30, 2007. Thankfully, everything went beautifully, so I'm trying to make sure everyone else's surgery goes smoothly as well!

    http://www.facebook.com/pages/Corrective-Jaw-Surgery/114627165257701
    Posted 1 year ago #

  6. antoinetiux
    Member

    I am 26 years old and I am with Blue Cross and they paid for everything! There's people working at the surgeon's office whose job is to get the insurance companies to pay for the surgery! Maybe you should ask the people at the doctor's office if they can help you with that, instead of you doing all the work with the claims.

    Posted 1 year ago #

  7. ashlea_hinkle
    Member

    Its been over a year and BCBS has still denied me. I still have braces on and I feel like I have tried everything I can think of, still no luck. Any suggestions?

    Posted 1 year ago #

  8. netsecure
    Member

    ashlea, thats strange! I also have BCBS but i dont think there is such restriction of not being covered if you are over 19. I havent yet had the surgery, i am still in the pre surgery braces phase, but i got confirmed through my insurance that they do cover jaw surgery 75%, which comes under restorative procedures......

    Please tell me more about this case of yours

    Posted 1 year ago #

  9. OpenBite
    Member

    Hi Ashlea. I'm very sorry to hear this. Unfortunately I'm not from U.S.A, and I don't have any informationa about this. In my case I still don't know whether the surgery will be paid by my the national health insurance, by my private health insurance, or by myself. Which is quite impossible because I don't have that money. I know one case, in my country, people have had a struggle with the insurance company, and then they had to pay the surgery. In my case, if they don't want to pay, I'll try to make pression,we pay a lot of money to be insured and it's not fair that, when you really need them, they tell you that you're not covered. If I were you, I'd try to speak directly with the right person of your insurance, and try again. I'm sorry to hear of your problem, I really hope you'll sort it out soon. Let us know what it happens. I have my 1st appointment on Tuesday,let's see what he says ...Maybe even on this forum someone could advise you some company and try it.

    Posted 1 year ago #

  10. ashlea_hinkle
    Member

    Hi guys, Its me again. I have been talking to SOOO many people about my case, Ive talked to several people through my insurance, Ive talked to my surgeon, my orthodontist, EVERYONE. I actually just got off the phone with BCBS and they still told me the same thing.. Yes my case IS medically necessary and YES I DO NEED THIS Surgery BUT because I am over the age 19 I will not receive any benefits!!! Ugh Im so frustrated. I asked her WHY is their an age discrimination and she said, as well as other people have said, BCBS thinks people should have this surgery sooner and not wait til there older?! Which in my case I TRIED to have this surgery when I was 13-14 but I was to young and they said I would have to have jaw surgery again if I was to have it at that age. SOO I waited and now Im screwed. My mom had actually sent them aletter to appeal it once before but they still basically said..Sorry its the policy.. and they cant go against the policy! Which is so frustrating.. SO now my only option is to try and get my old orthodontist and my old surgeon records back in 2003 to try and find records of any documents that would help in trying to appeal it again! Its just seems really unfair, now that Im 21, and Ive waited my whole life to have this surgery, my jaw is fully developed now and Ive had braces on for over a year with medically reasons why I need this surgery& BCBS still denies me. My only option is to find any and all documentations and try to convince them to go against the policy. Its stupid that I have to do all this but this is how bad I want/ need this surgery. If this doesnt work, I have no other options. All the money and time Ive spend in the last year with trying to have this surgery will have been a complete waste of time!:( and I will have to get my braces off ( which Ive paid 350$ every month for over a year now to have them) and No body else can seem to help me..I seriously dont know what to do.

    Posted 1 year ago #

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