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

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TheBostics
Posts: 16
Joined: Tue Mar 21, 2017 11:24 pm

Hello!

#1 Post by TheBostics »

I never get any responses on here - why is that?

Anyways, I am a 20 year old college student who is trying to get surgery to correct an underbite. According to my orthodontist, the underbite is a 5/6mm anterior crossbite with unilateral posterior crossbite on the left side, along with a mandibular midline shift to the right and a tilting of the mandibular bicuspids backwards. I am full Class III.

I have been consulting with orthodontists and jaw surgeons in the DC area (where I live), with the only hold-up in the process being my medical insurance. I started the process in June of this year.

I have a couple of questions:
1.) Does anyone know what specific underbite it could be?
2.) How did you conquer the hurdle of insurance? My insurance excludes this completely from coverage (ortho is covered)
3.) Does anyone else experience emotional ups—and—downs related to their jaw disorder? How did you deal with them?
4.) How long did your process take between consulting with medical professionals, to actually having the surgery?


I am a frequent visitor of these forums and it is great to know that you are not alone! I love the community here and encourage everyone in the process to keep pushing. We will be beautiful AND humble because of our struggle!

If anyone could take the time to respond, it would be well appreciated!

tdc10
Posts: 13
Joined: Mon Sep 18, 2017 9:26 pm

Re: Hello!

#2 Post by tdc10 »

Hi - hang in there! It's a long process but it'll be worth it in the end.

1) Would recommend confirming with your orthodontist / surgeons that you've consulted. Not sure if there's really a very specific "name" for your particular underbite, other than a Class III malocclusion with a few specific circumstances. I'd also focus on knowing which exact procedures you are a candidate for.

2) If your current insurance plan excludes orthognathic surgeries entirely, as defined in your plan's summary of benefits / covered services, unfortunately, I don't believe there is anything you can do with your current insurance provider. Given the extremely high costs of jaw surgery, I would highly recommend having the surgery take place when you are on a different insurance plan that covers jaw surgery. Ideally, you'd be able to find a surgeon that is in-network on a plan that covers jaw surgery, and in that scenario, you'd have protections like maximum allowable amounts and maximum out-of-pocket costs in place. Having the surgery 100% excluded from insurance coverage means you'll be entirely responsible for tens of thousands of dollars (perhaps several tens of thousands). Read up on the various threads here - the full costs tend to be quite high once you include surgeon's fees, hospital facility fees, anesthesia, etc. Insurance coverage and staying in-network makes all the difference - e.g., having a $5,000 annual max out of pocket limit on your insurance plan, which means you'll pay only $5,000 for all covered, pre-authorized procedures even if you are billed, say, $70,000 in fees related to said services. And remember, fees tend to be higher in major metro areas.

In the meantime, if your orthodontics are covered on your current plan, I'd take advantage of that and start with your orthodontic treatment, especially if you need a significant period of time before you are ready for surgery.

(3) I didn't really experience this myself, so I'd defer to the other threads where this is discussed on this forum.

(4) It took a little over a year for me from going to various consultations, choosing my surgeon, to finally having the surgery. I required a year or so of orthodontics before my bite was in the proper position for surgery, as is the case for many individuals who undergo jaw surgery.

There's a lot to learn over the course of the process of deciding to have surgery, choosing who to go with, making financial arrangements. This forum is a great resource.

TheBostics
Posts: 16
Joined: Tue Mar 21, 2017 11:24 pm

Re: Hello!

#3 Post by TheBostics »

Thank you for taking the time to reply!

So I am currently covered under United Healthcare's medical plan, which excludes orthognathic surgery except in emergency circumstances (i.e. accident).

Luckily, my mother works in the dental industry. She has consulted a surgeon that teaches at a local, well known college in the area. She has discussed my case with her and she is apparently eager to take it on. Although we have not discussed financials yet. I will be meeting with her next month to discuss in-depth.

snapdresser
Posts: 930
Joined: Wed Feb 18, 2015 7:31 am

Re: Hello!

#4 Post by snapdresser »

Very interesting, TheBostics! I had read about doing low-cost orthognathic surgery at a dental school but when I reached out to some, they were not receptive. Good to hear that some folks are having better luck!
No braces
1-piece LeFort I + BSSO + Sliding Genio on 10 JUNE 2015!
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Piper
Posts: 9
Joined: Sun Dec 17, 2017 11:28 pm

Re: Hello!

#5 Post by Piper »

1.) Does anyone know what specific underbite it could be?

Generally, there is not a set in stone name or specific type other than a Class III Maloclussion. Mine was a Class III with a slight cross bite.


2.) How did you conquer the hurdle of insurance? My insurance excludes this completely from coverage (ortho is covered)

My plan included it, but only if I was diagnosed with sleep apnea, cleft lip, and an accident - however I didn’t meet any of these requirements, yet my insurance still covered it; it really has to do with how your surgeon submits it to the insurance company. My case was medically necessary because I was unable to chew properly, struggled with swallowing food and caused pain. I too, have United Healthcare.

3.) Does anyone else experience emotional ups—and—downs related to their jaw disorder? How did you deal with them?

Of course the Surgery does help with self esteem, because the correction does fix your bite and causes a more proportionate facial structure - but there are few cases where some said they didn’t like the way they looked after Surgery (depending on the severity, looks can change drastically) - but majority of people are very happy with the results. To deal with it? Well, I think that varies with each person. Find a healthy outlet (exercise, reading, pick up a hobby, etc). Keep your mind off it.


4.) How long did your process take between consulting with medical professionals, to actually having the surgery?

For me it started in December of 2015. My dentist referred me to an oral surgeon to discuss my case (Class III underbite with a slight crossbite), after that I had the consultation with my oral surgeon in January of 2016; where he told me I would need to be in Braces for up to a year before my teeth would be aligned enough to do the surgery and he referred me to an orthodontist.

So, went to orthodontist in also January of 2016, and after X-rays, and my orthodontist having to speak with my oral surgeon, I was able to finally get my braces started as of March 2016.

I wore braces from March 2016 to Surgery date or November 2017. So I was in Braces for 18 months BEFORE surgery. They after surgery, my orthodontist said it may take another 6-8 months to fine tweak and remove the Braces.

So I’m gonna say it’s going to take me about 2 1/2 to 3 years for the entire process. But it’s definiteku worth getting - I’m just dealing with the numbness and stiff chin.

Hope this helps!!

TheBostics
Posts: 16
Joined: Tue Mar 21, 2017 11:24 pm

Re: Hello!

#6 Post by TheBostics »

Thank you everyone for responding!

I’ve met with the university surgeon referenced in an earlier post. The surgeon explained that I had hemimandibular elongation, otherwise known as unilateral condylar hyperplasia (possibly CH type 1B). There is a cant of my upper jaw and a horizontal shift of my mandibular midline to the right. My teeth are aligned enough to disguise the true extent of the condition.

If I can get braces put on before the end of February, I’m looking at surgery between July and December of 2018. Not much movement needs to be done according to them, and I previously had upper jaw expansion/braces/class III elastics during my childhood and teenage years. I will be working along with them to ensure the proper steps are taken (high condylectomy, orthognathic surgery) and that everything is settled permanently.

TheBostics
Posts: 16
Joined: Tue Mar 21, 2017 11:24 pm

Re: Hello!

#7 Post by TheBostics »

Bump for anyone interested.

I am now in braces, and my bite is starting to slowly change. It takes more effort to speak, especially with certain sounds and letters.

Turns out, I have not condylar hyperplasia, but mandibular laterognathia (or hemimamdibular elongation), confirmed by my surgeon who I hope to see this week.

Aiming for surgery at the end of the year, since this is my second round of braces and not much work needs to be done according to my ortho/surgeon.

TheBostics
Posts: 16
Joined: Tue Mar 21, 2017 11:24 pm

Re: Hello!

#8 Post by TheBostics »

Double jaw surgery to take place on December 4th, 2018. Hoping for the best!

TheBostics
Posts: 16
Joined: Tue Mar 21, 2017 11:24 pm

Re: Hello!

#9 Post by TheBostics »

Bump for question; I don't find it necessary to create a new thread.

Surgery went well, was banded shut for 5 weeks. Segmental LeFort I + BSSO surgeries performed. Still numb in both lips and chin but numbness on cheeks has almost disappeared.

I have been out of my splint/unbanded for two days now. Am getting my mouth open very slowly; progressing faster than I expected, can almost fit 2 fingers within my mouth without much pain.

Question: I feel a sort of pressure on my back left lower jaw when I chew anything sturdy, like fish or anything requiring a bit of chewing; almost like the jaw is coming downwards. Am still on a soft food diet for the first week.

Did anyone experience something similar? and did it ever go away? I had an exposed screw in that area due to the stitch popping, but the skin/mucosa has begun to grow over it and my surgeon made me aware to continue to be very cautious in that area.

kplatt2010
Posts: 260
Joined: Sat Jul 07, 2018 6:26 am

Re: Hello!

#10 Post by kplatt2010 »

Hi There-I would imagine that if your jaw has been banded shut for five weeks, it's normal to feel the pressure. However; I'm not your surgeon just someone who's had the surgery. My big issue after surgery was super painful popping. Similar to someone pulling back a rubber band and releasing it to your face. Wowsie that was SUPER painful.

How about the popsicle stick exercise? Are you doing that??My surgeon had me exercising with the popsicle sticks with a goal to get in 24 total to stretch open the jaw. You can get them at Michaels for like $4 in the kids craft area. In my case; it took me almost a full year to reach the 24 goal. I had a genioplasty 30 years ago though and back in the day they did not try to stretch. Opening my mouth prior to surgery for the dentist was very challenging. Not so much anymore though. :D The popsicle stick stretching helped in my case but I know other folks on the board who have had serious issues where they describe feeling as though they are wearing a horse bridle.

I think you're going to find that each surgeon does things a little differently and each case is different. I was on a liquid diet for at least 12 weeks and even after that it was soft for six months. Now that I'm 17 months post I can eat croutons and other crunchy stuff. I've tried eating almonds though and it was a no go.

Who was your surgeon by the way? Did a fellow perform the surgery? I actually went out of state for my surgery as I found that a lot of the oral surgeons do not take insurance. Especially these big cases as they can charge a lot of money. My total surgery would've cost $95 K if insurance had not paid.
Karla

TheBostics
Posts: 16
Joined: Tue Mar 21, 2017 11:24 pm

Re: Hello!

#11 Post by TheBostics »

kplatt2010 wrote:
Sat Jan 12, 2019 2:27 pm
Hi There-I would imagine that if your jaw has been banded shut for five weeks, it's normal to feel the pressure. However; I'm not your surgeon just someone who's had the surgery. My big issue after surgery was super painful popping. Similar to someone pulling back a rubber band and releasing it to your face. Wowsie that was SUPER painful.

How about the popsicle stick exercise? Are you doing that??My surgeon had me exercising with the popsicle sticks with a goal to get in 24 total to stretch open the jaw. You can get them at Michaels for like $4 in the kids craft area. In my case; it took me almost a full year to reach the 24 goal. I had a genioplasty 30 years ago though and back in the day they did not try to stretch. Opening my mouth prior to surgery for the dentist was very challenging. Not so much anymore though. :D The popsicle stick stretching helped in my case but I know other folks on the board who have had serious issues where they describe feeling as though they are wearing a horse bridle.

I think you're going to find that each surgeon does things a little differently and each case is different. I was on a liquid diet for at least 12 weeks and even after that it was soft for six months. Now that I'm 17 months post I can eat croutons and other crunchy stuff. I've tried eating almonds though and it was a no go.

Who was your surgeon by the way? Did a fellow perform the surgery? I actually went out of state for my surgery as I found that a lot of the oral surgeons do not take insurance. Especially these big cases as they can charge a lot of money. My total surgery would've cost $95 K if insurance had not paid.
Karla
Thank you so much for responding! It seems like I can never get a response on here!

So the pressure I assume is from awkward contact that my teeth are making; they do not fit together very well yet. I assume that as the weeks go by and the teeth start to straighten out properly, that feeling will eventually disappear. I have no popping or snapping sensation, so i can only be thankful for that! :D

My surgeon actually advised me not to use popsicle sticks to stretch the muscles as my upper jaw's front segment is not very stable yet; I was advised to place my fingers in the back and cross them to stretch the jaws, as well as active stretching throughout the day via talking, chewing, and forcing the mouth open with and without fingers. So far, it has been helpful; I will use the popsicle sticks only I see stagnation of the jaws stretching.

For privacy reasons, I won't name my surgeon; however, I understand that insurance is reluctant to cover this condition that we have (had?). I was lucky enough to be able to have my surgery done through a dental school in my area, by a surgeon who performs these surgeries on a near-weekly basis. I am paying out-of-pocket but the cost is not nearly as high (less than $25k total) and the majority of it is the hospital stay.

kplatt2010
Posts: 260
Joined: Sat Jul 07, 2018 6:26 am

Re: Hello!

#12 Post by kplatt2010 »

Good Morning,
I have BCBS federal which will cover the surgery when certain conditions are met. The primary reason that I had was sleep apnea. However; when I went for my pre-surgery visit, the surgeon said mine would be easily approved because of my large over-jet that occurred during the pre-surgery braces treatment. Of course, I think my surgeon goes through the insurance "back door" by obtaining approval as an outpatient procedure. In hindsight a crazy approach for a surgery that lasted 8 hours in which I had significant blood loss. I had the full works too with an arterial line, foley, etc.

Subsequently; my insurance company audited my chart after a non-provider intensivist (attending covering step-down intensive care unit) requested that I appeal their non-provider payment. That opened the audit door and now the insurance company (who paid everyone 17+ months ago) is demanding their money back and to have everyone resubmit as an outpatient. Their rationale being when they audited my chart they noted that I left after the 23 hour / 59 minute rule and was "ambulatory". The ambulatory description was inaccurate and not the case and thinking with hindsight; I should have stayed hospitalized at least another day or more.

Insurance companies operate in the black and white only. You have to have every "i" doted and "T" crossed with the insurance companies for this particular surgery.It's been quite challenging and frustrating dealing with them.
Karla

TheBostics
Posts: 16
Joined: Tue Mar 21, 2017 11:24 pm

Re: Hello!

#13 Post by TheBostics »

kplatt2010 wrote:
Sun Jan 13, 2019 11:14 am
Good Morning,
I have BCBS federal which will cover the surgery when certain conditions are met. The primary reason that I had was sleep apnea. However; when I went for my pre-surgery visit, the surgeon said mine would be easily approved because of my large over-jet that occurred during the pre-surgery braces treatment. Of course, I think my surgeon goes through the insurance "back door" by obtaining approval as an outpatient procedure. In hindsight a crazy approach for a surgery that lasted 8 hours in which I had significant blood loss. I had the full works too with an arterial line, foley, etc.

Subsequently; my insurance company audited my chart after a non-provider intensivist (attending covering step-down intensive care unit) requested that I appeal their non-provider payment. That opened the audit door and now the insurance company (who paid everyone 17+ months ago) is demanding their money back and to have everyone resubmit as an outpatient. Their rationale being when they audited my chart they noted that I left after the 23 hour / 59 minute rule and was "ambulatory". The ambulatory description was inaccurate and not the case and thinking with hindsight; I should have stayed hospitalized at least another day or more.

Insurance companies operate in the black and white only. You have to have every "i" doted and "T" crossed with the insurance companies for this particular surgery.It's been quite challenging and frustrating dealing with them.
Karla
American insurance companies are indeed the devil. With a malocclusion, they only find it necessary to operate only if there is an associated medical condition; something I find ridiculous as the malocclusion is by itself a medical condition; albeit a "natural" occurence.

Dealing with them constantly rejecting my appeals was frustrating; my insurance denied my surgeon's initial request and our appeals; they even refused to cover the hospital stay.

kplatt2010
Posts: 260
Joined: Sat Jul 07, 2018 6:26 am

Re: Hello!

#14 Post by kplatt2010 »

Yeah I agree with you regarding the insurance companies. When I got a $7K bill from the anesthesia folks after they had already been paid; I freaked out. Then I made a million phone calls trying to figure out what was going on and how to resolve it. I think it's going to be resolved but BCBS has been so blase saying "this is not your issue; this is between BCBS and the providers. You do not need to do anything". Really??!! Do I just ignore bills and assume BCBS is going to be a good communicator? They are the worst at communicating, the anesthesia folks had NO CLUE why BCBS wanted the money back.

Unfortunately the folks that bill do not make phone calls. They email and send snail mail. Sometimes you just need to pick up the phone and speak to a live person.

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