Would insurance cover braces and not surgery?

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HoneyBee245
Posts: 16
Joined: Tue Dec 18, 2018 10:02 pm

Would insurance cover braces and not surgery?

#1 Post by HoneyBee245 » Tue Dec 25, 2018 6:58 pm

I got full approval for my braces, but they have not sent out pre approval for my surgery yet. I’m eight months in a one year treatment. I’m going to make an appointment with my surgeon for him to send out pre approval request. My fear is of course my surgery won’t be approve and I’m left worse off than I was, because I can’t bite normally anymore at all and I’ve develpped speech problems. I always did have chewing problems but not this severe. I have Medicaid I’m scared they won’t covee the surgery since it’s so expensive. Do any of you know if it’s common for them to cover braces and not surgery?

SDFD TSchott
Posts: 1680
Joined: Sun Aug 20, 2006 11:36 pm
Location: Tucson, AZ

Re: Would insurance cover braces and not surgery?

#2 Post by SDFD TSchott » Tue Dec 25, 2018 9:43 pm

I could be wrong but who knows I personally don't think they will cover it unless it's 'Medically Necessary'. I know with my own insurance they will not cover it unless 'Medically Necessary' however they covered up to 1,500 for my braces.

Image

Adjustment Sept 14th, 2018
Braces back on August 06, 2018
Braces off April 02, 2008

HoneyBee245
Posts: 16
Joined: Tue Dec 18, 2018 10:02 pm

Re: Would insurance cover braces and not surgery?

#3 Post by HoneyBee245 » Wed Dec 26, 2018 12:24 am

Isn’t not being able to eat or speak medically necessary or is that not considered that?

SDFD TSchott
Posts: 1680
Joined: Sun Aug 20, 2006 11:36 pm
Location: Tucson, AZ

Re: Would insurance cover braces and not surgery?

#4 Post by SDFD TSchott » Wed Dec 26, 2018 9:06 am

Depends on how the insurance company sees it. My son is going through speech therapy and insurance denied his claim saying it's not Medically Necessary even though he has difficulties and is Autistic

Image

Adjustment Sept 14th, 2018
Braces back on August 06, 2018
Braces off April 02, 2008

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

Re: Would insurance cover braces and not surgery?

#5 Post by kplatt2010 » Wed Dec 26, 2018 8:05 pm

Hi HoneyBee,
The best person to answer whether Medicaid will pay will be the surgeon. I would imagine that medicaid would have similar qualifications for why they would pay for the surgery as commercial health insurance.

I have BCBS federal and I know in my particular case, the surgeon had shared with me that sometimes the insurance companies may initially deny requiring the surgeon to submit additional details to qualify. In my case though, I remember when I went back that he told me I would not have an issue qualifying as the ortho had over-corrected significantly and that this would qualify me alone.

Take it one step at a time, you've been doing the necessary steps to get the issue corrected. It may be approved right off or you might have to have the surgeon submit additional documentation. Don't give up. You've come this far.
Karla

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