extration Ortho mDO sleep study before or after buying new Insurance for best rates/coverage?

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paddingtonbear
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Joined: Tue Oct 13, 2020 2:46 am

extration Ortho mDO sleep study before or after buying new Insurance for best rates/coverage?

#1 Post by paddingtonbear »

Hi People!

I've been a longtime lurker on this forum but I now have an insurance question that I can't figure out on my own

Background:
I'm mid to late 30's, female. extremely small lower jaw, small upper jaw
I have an extremely, extremely small airway, made smaller by crappy camouflage extraction orthodontics a dozen years ago. The Ortho is now retired from her clinic, somebody else took over and "hasn't kept" any records. In fact after ortho treatment, i can only close my bite by pushing my lower jaw forward to fit my teeth together partially. ONe side has a medium cant too-one side doesnt close whent he other side does. My Ortho, SHE REALLY should have referred me to a max fax but never did. had severe class 2

I've seen alot of the "big names" and local max fax docs and they all told me I almost definitely have sleep apnea and need lower jaw advacement and counter clock wise rotation. How bad of sleep apnea ? Unknown. I have all the signs like restless leg/tossing turning (sleep on floor matress due to this), constant brain fog, falling asleep when being still, headaches, heart palpitations but no heart issues, no psych,no neuro, anything detected after extensive workup, ADHD (doesnt even run in family), crappy memory, extensive teeth grinding, etc. I've been in multiple car crashes, all my fault--I don't drive anymore since I'm afraid of hurting somebody or myself eventually. nap twice a day in car at work and sleep 10 hours a day at night. I believe it's all due to my super small airway. DOn't want to live like this anymore :(

Never been tested and never been on CPAP.

The Issue:
Currently have United Health Care through work, which excludes all Orthognathic surgery except for sleep apnea.
However, I don't trust them to approve it for even that. Why? They denied my in-lab sleep study request even though my symptoms fit the coverage criteria for an in lab sleep study, and made me do an at home sleep study (not known for accuracy) to see if it was really bad enough; only then could get an in lab. My sleep doc even did a peer to peer appeal and it was denied. The doc from United healthcare that denied me wasn't even in the sleep medicine field LOL.
"Thankfully," due to my restless leg, an electrode lead in the at home sleep study hookup machine, popped off. Now, United Healthcare FINALLY is approving me for an in lab sleep study.

The questions:
My company is switching health insurances in a few months. Since it's a small company, we all have a say in which health insurance plan. Everybody there hates united health care as they are blanket rejecting alot of things and then expect you to appeal even when you meet criteria OR there are exclusions everywhere. My poor coworker got her arthiritis meds denied until she appealed twice even though she fit criteria. Its like they are blanket rejecting people--so shady!!!

Now that my in lab sleep study finally got approved, should I got ahead and do it? Or should I get it done AFTER I buy my own, extra, private health insurance and switch over to the new insurance (in addition to whatever my company ends up getting us) so that It's like I went into the new self-bought insurance as If I "DIDNT" have sleep apnea since it's undiagnosed/no sleep study test done and thereby my rates would be lower? Since I'd be getting diagnosed AFTER I got the new insurance. Of course I would check the self bought insurance to make sure it had less restrictive jaw surgery criteria and i met the conditions before buying it.

I am also visiting my cousin in a 3rd world country this holiday, he's working there for a year, and he has been trying to convince me to get a sleep study done there to figure out if I even have it bad enough to get insurance to cover sleep apnea jaw surgery. That way, If I have it, insurance in the usa wouldn't know and I could go ahead figuring out which private pay insurance to buy on top of company insurance and then get another insurance-approved, "official" sleep study to get that on record AFTER I get the new self initiated supplemental insurance. .

but, then again, if I go with a "big name" max fax doc (who are all out of network with all insurances) maybe the above doesn't matter anyways??

I'm just so tired of fighting my insurance on everything.



Additional orthodontist question:
I was told by some dental hygienist doing my photos during the max fax consults that extration camoflauge orthdontics can actually make the airway even worse that it is. However, she also told me most max fax won't admit to this, as they don't want to speak ill of orthodontists that they may need to work with in the future or cause drama. I got all four bicupsids pulled and can't close my bite unless i posture my jaww forward alot. even then there is a cant on one side. Might my ortho have worsened my airway by pushing my teeth and by extension, the soft tissue back?

paddingtonbear
Posts: 2
Joined: Tue Oct 13, 2020 2:46 am

Re: extration Ortho mDO sleep study before or after buying new Insurance for best rates/coverage?

#2 Post by paddingtonbear »

as a clarification to the ortho issue--I am only assuming they pushed my teeth back when it was braced; i had a super duper small mandible bone and then they pulled 4 teeth out so i'm guessing they had to have pushed teeth back to make it look straighter whilst cutting off my already small airway?

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