Is insurance coverage all or nothing? How much were you covered?

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2ndtimesthecharm
Posts: 4
Joined: Sun Mar 26, 2017 11:19 am

Is insurance coverage all or nothing? How much were you covered?

#1 Post by 2ndtimesthecharm »

Hello all!

It's been a little more than a few months since I last posted, and I have made some progress with the hopes to correct my past orthodontic treatment. All I can say is f#%k my old orthodontist, because it's going to cost a lot of money to fix his handiwork. I sincerely hope he's no longer practicing.

I found a surgeon that I feel comfortable with, and although I am still cautiously optimistic about the whole process, I really hope I can continue moving forward. The part that is really scaring me is the price. I am very grateful that I will not need braces for longer than a few months, so that is one less expense that I will have to worry about long-term. The surgeon said I will have some kind of braces fixed to my teeth a few weeks before and after the procedures, but that's it. This is only because my old orthodontist was able to get my bite/teeth into a workable position while camouflaging the skeletal deformities I was developing. He treated me for 11 years, so I believe his drawn-out treatment plan, the years-long use of high-pull headgear/braces, and the 4 adult teeth I had extracted at a young age are the reasons for my issues now.

For the surgeon's fees alone I was quoted almost $20,000 for a BSSO, Lefort 1, and a genioplasty. I will have to pay the full price of the genioplasty, but they were posing that the other two might be somewhat covered by my insurance. I am not as optimistic, and I'm expecting that have to pay that total out of pocket. The next immediate step for me is having a CT scan so the surgeon can take a better look at my soft tissue and airway.

I've been saving for a while and feel confident that I can cover the majority of the surgeon's fee on my own, but I start feeling anxious when I think about all of the other fees that haven't been accounted for yet. The OR room costs (I've read quotes of $60+ p/minute), anesthesiologist, over-night inpatient care, and probably even more fees that I don't even know about yet. Even if my insurance denies the cost of the surgeries, can they deny coverage of the care I'd need in the hospital? Is there a chance I'd have to pay all of these expenses out of pocket? My surgeon will perform the operation at a hospital that is in-network, but I don't know if that matters.

I should be hearing back from the surgeon's office this week about what my insurance will be able to handle, but until then I'm just over-thinking and freaking out! I know my case is pretty unusual, so I don't know if anyone out there has been through something similar.

Thanks for reading through all this, I appreciate any insight you guys would have! :)

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ProudMama1015
Posts: 15
Joined: Mon Aug 07, 2017 9:33 am
Location: Orlando, FL

Re: Is insurance coverage all or nothing? How much were you covered?

#2 Post by ProudMama1015 »

My total cost was $3950. Well thats what they estimated to me. My out of pocket expense is $2400. Which kind of stinks but it is what it is.

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kpw818
Posts: 122
Joined: Thu Jun 20, 2013 8:59 pm
Location: Colorado

Re: Is insurance coverage all or nothing? How much were you covered?

#3 Post by kpw818 »

My surgeon's fees were somewhere around 30k, then I had the hospital fees. I paid 3k out of pocket and my insurance covered the rest.
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FlyByNight
Posts: 208
Joined: Sat Mar 18, 2017 11:07 am

Re: Is insurance coverage all or nothing? How much were you covered?

#4 Post by FlyByNight »

I had metal braces with 6 clear brackets. I paid a little under 900 here in Canada. Insurance covered the rest.

snapdresser
Posts: 996
Joined: Wed Feb 18, 2015 7:31 am

Re: Is insurance coverage all or nothing? How much were you covered?

#5 Post by snapdresser »

If your insurance determines that the procedures aren't medically necessary, then no, they won't cover the hospital stay either. They won't cover anything at all. But good luck, I hope you get coverage!
No braces
1-piece LeFort I + BSSO + Sliding Genio on 10 JUNE 2015!
Partial hardware removal 14 SEP 2018
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