I amreally confused as to how i should go about getting a medical insurance to cover surgery. I have not had insurance for about a year or so now since I gradutaed from college. My question is everytime I talk to the insurace agent , they tell me that since I am not yet a member of their isnurance they cannot tell me whether or not the orthognathic surgery is covered by their company. They said that I would have to first apply for the insurance and once I get approved for it, I shoudl then buy the insurance. It is only after that the surgeon submits all the paperwork for the surgery. It is then decided wherether or not the insurance will cover surgery depending on the medical necessity of having the surgery.
Is that how it goes? I mean i feel like i should atleast know whther or not the insurnace covers surgery before I enroll for it right? I dontwant to pay for smthing just to find out that i am not getting covered for insrance. Plezz help
Insurance runaround .HELP PLZ
Moderator: bbsadmin
I understand that you would like to know if your surgery is covered before you commit, but from their point of view this kind of thing would allow some people to purchase insurance just before they need an expensive procedure done.
So I don't think you will get a straight yes or no before you commit. However, if you can find some other people with the same plan you are thinking of purchasing and that went through the same surgery you might get a better idea of what your coverage will be under that plan. Keep in mind that a waiting period may apply under certain conditions like yours since you have been without health insurance for quite some time. I'm not certain, but that waiting period can be up to a year. Which means you may have to have coverage for up to that long before you can file with your health insurance company to verify medically necessity and how much coverage you will receive.
So I don't think you will get a straight yes or no before you commit. However, if you can find some other people with the same plan you are thinking of purchasing and that went through the same surgery you might get a better idea of what your coverage will be under that plan. Keep in mind that a waiting period may apply under certain conditions like yours since you have been without health insurance for quite some time. I'm not certain, but that waiting period can be up to a year. Which means you may have to have coverage for up to that long before you can file with your health insurance company to verify medically necessity and how much coverage you will receive.
Typically insurance won't cover anything beyond check-ups if you've not held the coverage for at least 6 months, in my experience
32 years old, total time in braces=30 months
-Braces and palate expander on 4/15/10
-RPE Surgery 9/15/10
-Expander removed 3/11
-Braces Removed 9/7/12
-Retainers in 9/7/12
-Braces and palate expander on 4/15/10
-RPE Surgery 9/15/10
-Expander removed 3/11
-Braces Removed 9/7/12
-Retainers in 9/7/12
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bracesscared
- Posts: 74
- Joined: Fri Nov 20, 2009 12:39 pm
Did u have kaiser right before ur ortho treatment or did u always have Kaiser. Was there any waiting period?dvdrdiscs wrote:Kaiser seems to be one of the more lenient insurance company to approve jaw surgery. But as someone said earlier, don't expect to buy insurance and be approved for an operation right away. You'll need at least a few months of coverage.
I had Blueshield PPO for a good period. My orthodontist uses a guy from Kaiser so the plan was for me to switch my insurance to Kaiser when the day gets closer for me to get surgery, which was what I did. It's not really a matter of who you have but more of if you had insurance. Since I had Blueshield prior to Kaiser, I had no gap in coverage. The first time I went to consult with the Kaiser surgeon, I've only been a member of Kaiser for about 3-4 months. But they can't deny me the surgery through the pre-existing condition clause because I was with Blueshield prior to them with no gap.bracesscared wrote:Did u have kaiser right before ur ortho treatment or did u always have Kaiser. Was there any waiting period?dvdrdiscs wrote:Kaiser seems to be one of the more lenient insurance company to approve jaw surgery. But as someone said earlier, don't expect to buy insurance and be approved for an operation right away. You'll need at least a few months of coverage.
Yup. This is very true. It's to protect insurance carrier from people who sign up just for an expensive surgery.boatsink wrote:I've only been with kaiser for 8 days and I saw my surgeon. I was approved right on the spot. However, note I did not have any time lapse without insurance from my previous HMO plan when getting on with Kaiser.