Its true......

This forum is for discussions relating to oral surgery for orthodontics.

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Its true......

#1 Post by knockuout7788 »

.........NO insurance will ever EVER cover orthognathic surgery, it can be really stressful AND you would have to be REALLY really really lucky to have it covered!! For those of you who did, i bet you feel blessed and happy. I just found out today my surgery is over $15,000! No way i can afford that! Thank GOD i have medicaid, which means my surgery will be free....... .........:lol:

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#2 Post by theKurp »

Just to add to this, to date my ortho has stated that I will only require lower jaw advancement surgery. After a consultation with an oral surgeon paperwork was submitted to my insurance company. Unknown to me, the oral surgeon requested coverage for both upper and lower jaw advancement + genioplasty - just in case.

The insurance company responded 4 weeks later and approved everything but the genioplasty. Both the ortho and the oral surgeon said I have a good chin in terms of facial balance so I can only assume that it's standard practice for my oral surgeon to submit requests for everything - "just in case".

My medical is 80/20 so I'll still be responsible for 20%, but that's pocket change in the grand scheme of things.

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#3 Post by crazybeautiful »

For all the bad press the NHS gets (particularly from someone here a while ago to, if I remember correctly :roll: ), it certainly helps everyone to care, and for some that they might not otherwise be able to afford. I'm certainly glad to have it :D

Don't know how the US insurance stuff works, but there's always a way if you persevere I think. (sorry if that sounds overly-naive!)
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#4 Post by ElenaM »

I'm a Canadian citizen but I live in the U.S. Is it possible to go there to get the surgery?

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#5 Post by Audra »

Go where? To Canada?

Unless you pay provincial health care in Canada, you cannot be covered under the health care system here (in Canada).


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#6 Post by Laundraholic »

ElenaM wrote:I'm a Canadian citizen but I live in the U.S. Is it possible to go there to get the surgery?

do you still have a health card?
Once you're out of the country for a few months, I think you're supposed to notify the Ministry of Health who invalidates your health card (but many people don't do this).

But even people arriving here as landed immigrants must wait 3 months before being eligible for a health card.
I think that it also applies when moving from province to province (although I believe your old province's health card is supposed to cover you for the 3 months until you can apply for the new province's health card).

also keep in mind that for me (in Ontario), the surgery is not "free".
I still have to pay for the surgeon fees (which hopefully my workplace health insurance will cover -- to be honest I haven't even enquired about it yet. If its covered, then its covered. If not, I'm prepared to pay for it out of pocket as I waited 13 years to get this done and the cost was actually a lot less than what I had been imagining it to be).

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#7 Post by smile2006 »

My surgeon also sumbitted for upper and lower even though initially we thought it would be only upper. Glad he did because I ended up with both upper and lower. In a suprise moment, my insurance even covered genio which wasn't pre-approved. So insurance is always weird, keep trying if you are denied!!!

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#8 Post by edinburger »

I am based in the UK. My private health insurance (provided through my job) initially declined my claim but subsequently accepted it when my orthodontist sent them some 'before' pictures and explained the functional issues associated with my open bite.

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#9 Post by Figamentation »

Initially, my insurance approved both an upper and lower jaw surgery. So I started going with my braces and such. I then changed jobs and got what was considered "superior" medical insurance, but unknown to me it was one of the policies that specifically excluded these surgeries in all cases. So my surgeon and orthodontist worked together to get me the surgery free of charge, even the hospital bill is being subsidized, the only caveat is that I had to have the surgery at a county instead of a private hospital (but the same surgeon). There's always ways around these things, you just have to cry and beg and appeal and find a way to do it!

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#10 Post by switchblades »

Atlantic Blue Cross in Canada considers it cosmetic, but recently, the Nova Scotia MSI system began to pay for functional cases on a case-by-case basis. This is fantastic news for me, because I've been told by about 8 different ortho's that I need the surgery, because the first time I had braces my ortho was a twit and refused to fit me with an appliance to fix my bite. Now I'm 22 and it's too late, and the grinding, twisting, locking of my jaw is getting worse. :(

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#11 Post by Lushpulp »

I am more proof that insurance does approve this surgery! The first submission was denied because there was no molds showing a deformity. Well the OS asked my OD to send over her molds and x-rays and waa-la it was approved! so you can get insurance to approve this!

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#12 Post by sauerkraut »

When I initially asked my kids' ortho about treating me, he said that as an adult I would have to pay for everything myself. Then he did the records appointment and it turned out I would need surgery. And suddenly the ortho treatment was covered by our health insurance. It wasn't exactly automatic -- the ortho and surgeon had to submit a report demonstrating clinical need - - but essentially it was me needing surgery that actually got my treatment paid for.

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#13 Post by bstndance »

I have Kaiser HMO. They're different because they own their own hospitals and doctors. They have an OS on staff in the Head and Neck Surgery Dept so they cover whatever he feels is relevant. I only paid the co-pay $150 for the surgery and $20 for each consultation.

Oh I did have to pay for x-rays. Cephalometric and panarex (sp ?) are considered dental x-rays and Kaiser doesn't cover them. The OS would request them from my Orthodontist who would sent me to a lab.

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#14 Post by gatorseh »

The total cost of my surgery was $49,000. Granted I have insurance, I am still paying $5,000 out of pocket. $15k compared to $49k doesn't seem so bad to me. :shock:

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#15 Post by Thathrill »

insurances can be tricky and sneaky. I was originally told by my OS that my insurance wouldn't cover my BSSO and that he hasn't seen one approved in over a year. I was with my work's (university's health insurance) I called my insurance and they said if a in network doctor recommends it then it will be approved and it was 4 weeks later. When I told my OS of the approval he was shocked. very shocked lol
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