Question about Surgery

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ahand123
Posts: 7
Joined: Wed Jun 04, 2008 6:54 pm

Question about Surgery

#1 Post by ahand123 »

Well, I have gone in for a consultation with an orthodontist and he said I was a surgical case. My lower jaw needs to come forward for the teeth to fit together properly. I brought up the fact that I have lip incompetence+ gummy smile, and he mentioned that upper jaw surgery was a possibility. If the teeth will fit together if the lower jaw is just moved, then how will an insurance company view the upper jaw surgery (assuming the lower jaw surgery would be covered if done alone)? Will they deny coverage for everything, or just the surgical fee for the upper jaw? Of course, I still need to talk to an oral surgeon about everything.

chipmunkcheeks
Posts: 206
Joined: Wed Jul 11, 2007 3:59 pm
Location: Long Island, NY

insurance

#2 Post by chipmunkcheeks »

i had an interesting situation. i was in need of upper, lower, and genio no matter what insurance said because of all of my issues.

both of my surgeries were covered in a blanket approval in '07.

i had sarpe and it was covered that summer.

then this year my surgeon went and resubmitted for the second surgery and lower and EVEN genio were covered, but not the upper. i called the surgeon immediately and was like how could they do that; the numbers show clearly that i have a MAJOR discrepency, therefore requiring both surgeries.

i should have saved the weekend of tears and anxiety since i recieved the letter on a friday night...

the surgeon said that the insurance company does this (not covering part of the surgery), even if medically necssary, so that he could charge me out of pocket for something so that he could make some money on my case. having an amazing surgeon, he said that he would never charge me for something i clearly needed because of the insurance company.

all i paid was the $500 hospital copay, since that is all i pay once i am admitted, and i probably owe the surgeon $50, but insurance hasnt put it through yet for him to bill me.

i'm one of those lucky ones...i have a $100K face for about $7,700. (braces being 94% of this total cost)

you are lucky though, if your surgeon does charge you, it would only be for the extra work, since you will already be under, etc. at least it wouldnt be upwards of 30,000-60K like if nothing was covered at all....

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