Denied (Well, sorta!)

[BracketRacket]

And the journey continues...hopefully having SARPE soon, with a bone-borne expander being placed...fun!

My insurance calls the other day, and says that pre-authorization was denied because (drumroll!) they need a study done showing I am done growing. They say it's not medically necessary to fix a crossbite with surgical expansion unless I am done growing.

Apparently the fact that I'm 25, 5'1'' and have been for over a decade isn't proof enough. It's always great when the person from the insurance company basically tells you it's bogus on the phone! Maybe I really will be 6'5'' one day!

Hopefully it's no biggie (pretty sure they just need an x-ray showing growth plates) and that they'll approve it when they get one, but come on...grr. They better not turn around and refuse to pay for the test, saying that's not medically necessary!

Anyway, just curious if this is a common thing, or if I'm just special! At least I learned a bit more about the terminology of the exact procedure planned (off to Google I go!) and that it's technically considered facial reconstruction (well, in that case...)

[DrBlur]

I'm having SARPE as well and am just waiting for the authorization from insurance...I'm older than you (30) so hopefully won't have the "done growing" problem (I can't believe they said that to you!)

[Steph in Sac]

Gave me a good laugh!

[DrBlur]

I hope I'm done growing now that I'm 30!

[qwertz1]

did they write "done growing"? because you can do a non-surgical expansion when you're done growing.
it depends on the "ossification" of your upper jaw I believe it is called. I don't believe there is a test for this, so orthos usually use an arbitrary cut-off age or try non-surgical first and if it doesn't work do the surgery.
maybe this is what your insurance is trying to achieve?

[BracketRacket]

did they write "done growing"? because you can do a non-surgical expansion when you're done growing.
it depends on the "ossification" of your upper jaw I believe it is called. I don't believe there is a test for this, so orthos usually use an arbitrary cut-off age or try non-surgical first and if it doesn't work do the surgery.
maybe this is what your insurance is trying to achieve?

Nope -- they wanted documentation of "cessation of growth." They denied a second time without it (that's a whole 'nother story grr). Had the x-ray this morning, results should be on their way and then hopefully everything else for the appeal will be on its way. When I went to schedule the bone age test, the woman (who, mind you works at a radiology practice and schedules thousands of tests a year) asked me (over the phone), if I was a "little person." Apparently, that was the only logicial reason she could think of that I would need the test. I explained. She laughed. Yay for bogus insurance "rules".