APPROVED at LAST

Message

#1 Post by **iBorg** » Sun Oct 05, 2008 7:06 am

After having my insurance in the approval stage since late June, last week I got my call telling me that I had been approved. My ortho is shocked and credits a lot of it to me making a bunch of calls and trying to keep all the doctors who submitted things on the same page. We both also credit a great case worker who I got to know well during this stage who also had her children treated by my orthodontist. Could not of hurt!!!!

I asked about surgery in November and my ortho told me there is no reason to hurry. She wants everything as close to right before surgery. So I'm on track for either May or June.

Mike

#2 Post by **Andantae** » Sun Oct 05, 2008 8:01 am

******AWESOME!!!*****
I would have to agree with your doc that your tenacity & diligence has finally paid off! Good for you, Mike! Great, too, that you were able to get to know your case worker so well---never hurts to have someone you know going to bat for you.

I asked about surgery in November and my ortho told me there is no reason to hurry.

Hurry? Your case has never struck me as being hurried!

I know you are limited by your work as to when you can have surgery, but what needs to happen between now and May?

Can't wait to be 'identicial' again!

Andi

#3 Post by **gatorseh** » Sun Oct 05, 2008 8:19 am

Congratulations!

I am so impressed that you have approval so early. Mine came nine days before my surgery (talk about stressful!).

#4 Post by **iBorg** » Sun Oct 05, 2008 11:48 am

I can not say how it felt to hear the magical words "you're approved." Still not cheap as I have to pay 20% but it is doable. When Jill, my insurance caseworker told me I was approved I was in such shock I couldn't even respond correctly.

I'd really love to do this in November but my ortho wants the space originally intended for implants to be fully closed. I'm not sure what else she has in mind prior to surgery. I'm almost scared to ask.

I do know Dr. P has moved more slowly in my case than I'd liked. Also since she is paid for the treatment versus a per moth basis I assume she has good reason to take things slowly. It could be my age at 50 or she's working around my TMJ issues.

THANKS for the well wishes! I so want to look like my twin! (inside joke)

Mike

#5 Post by **Andantae** » Sun Oct 05, 2008 12:28 pm

Absolutely, best to have it done well and err on the side of caution. To me, you are always so kind and patient---never needing to push or hurry:) Soooo happy for you!

#6 Post by **Steph-in-WI** » Sun Oct 05, 2008 2:12 pm

Congratulations, Mike, on your approval! I am sure you are thrilled. After all the time and energy that goes into filing an appeal and following up, you deserve the good news!

#7 Post by **FuzzyPants** » Sun Oct 05, 2008 6:29 pm

Hooray! That is great news, especially after the long journey to get to this point.

#8 Post by **kaycee** » Sun Oct 05, 2008 6:35 pm

Whoo hoo Mike, that's great news!! Do the dance!

So I'm guessing your orthodontist wants your bite to be as near to perfect as possible before surgery so you'll just have a little fininshing up to do after?? Well, here's hoping.

I also had to have my gaps all closed up before scheduling surgery, the rest of me was beyond ready except for those pesky little gaps, all four of them. But they did move, albeit at their own little pace (and I mean little). But lo and behold, you'll be ready before you know it.

kaycee

#9 Post by **iBorg** » Sun Oct 05, 2008 7:58 pm

Andantae: Kind, patient.... me? Do you have the right iBorg? I'm the one who volunteered for headgear if it would get things moving quicker. Dr. P didn't take me up on that.

Steph-in-WI: I didn't file an appeal. I was approved on the first submission. What I did do, when the process seemed to take forever, what handle it like an appeal. Gather EVERYTHING I could and try to find the right combination to sell my case.

Meryaten: Resident expert.....I just didn't quit. I learned to ask questions from this group. I think my insurance company knew I wasn't going to quit. I asked two very important questions; (a) what are your specific criteria (they weren't sure....that might be a problem for them) and (b) if I'm not approved I made it known I expected a detailed alternative treatment plan. Expert.....no....just lucky.

FuzzyPants: This journey is only halfway finished. I asked my ortho in September how much longer and she said about two years. Now the family joke is which iBorg will be out of braces first. Lil' iBorg who just finished phase 1, Princes iBorg who has yet to start or Daddy iBorg who started first.

kaycee: I have no idea what all she want's done. I'd love to say she wants my bite near perfect before surgery. With my jaw cant and length issues, that won't happen. She did switch from Class 1 to Class 3 elastics this last adjustment to help my TMJ. With Class 1's (which she liked for the added anchorage) my TMJ was out of control. I hugged a heating pad more than my wife and kids. Heck, I should have dated the thing as much as I used it.

Thanks for the well wishes, now the next count down begins.

Mike

#10 Post by **PuppySmiles** » Sun Oct 05, 2008 8:35 pm

Wow, congrats!

Uh, "caseworker"? Is that someone who works at your orthodontist's office?

I'm just beginning the journey. Looks like I should go back and check for your other posts, see what you did right!

#11 Post by **Thathrill** » Sun Oct 05, 2008 10:06 pm

wow congrats on the approval. really shows that hard work and diligence really pays off

#12 Post by **Arvensis** » Mon Oct 06, 2008 8:41 pm

YAY!!!!!!!!!!!!!!!!!!!!!!!!!!!

This is great news to see upon returning from post-hurricanes/power/moving/working month!!!

CONGRATS!!!!!!!!!!!!!!!!!!

#13 Post by **phil** » Tue Oct 07, 2008 4:34 am

iBorg,

CONGRATULATIONS! What a long haul it has been for you.

Be well, and at peace,

Phil

#14 Post by **badbite** » Tue Oct 07, 2008 12:44 pm

That is great news!

#15 Post by **iBorg** » Tue Oct 07, 2008 8:54 pm

PuppySmiles: My insurance, and I assume others, has a caseworker for claims that involve pre certification. She is responsible for gathering all the bits and pieces so that your case can be evaluated. I was lucky in that my case files took a long time to be completed. If only the information from my surgeon was considered I'm certain I'd been turned down. Instead what should have taken thirty days took over three months. During that time, I took the approach that I should gather all my documentation and approach this as if this was an appeal of a denial. Anything that I thought might justify the surgery I tried to get medically documented. I coordinated the information from both my general dentist and my orthodontist so that they both reflected each other's opinions. My advice early on is to ask your ortho what justifies surgery in your case. Explore what has helped others get insurance approval. Does their conditions match yours? Make a list. Do your leg worth. Getting approval is like a second job.

Thathrill:I'm not sure I did that much work. I just asked for support letters from any medical professional that I thought would help. Sometimes they would submit a letter, often they wouldn't. Phone calls aren't hard work. Taking care of someone after surgery would be.

Arvensis: I hate to hear about your return. I take it you were hit hard. I hope that life wil settle down soon for you. Thanks for the well wishes.

phil: I think I know your faith. I hope you will keep me in your thoughts and prayers when I approach surgery. I can only hope my experience is no where near as long as yours. To maintain a positive attitude after all you've been through is inspirational.

badbite: I was so excited I didn't know how to react. It will be interesting to see how I react when my ortho says "schedule it."

Thanks for the well wishes and pleasant thoughts.

Mike