Questions about Insurance and getting approval for this surgery.

[gobinator98]

Hello Everyone!

I live in Wisconsin in the US and I am looking for alternative insurance to have my orthognathic surgery approved as I cannot pay the estimated $75K+ in hospital fees, surgeon fees and everything else. So far United-Healthcare of Missouri denied me because I didn't meet their restrictive criteria for having coverage. I also had my mom add myself to her insurance to see if I could get coverage under it.....was ultimately told that they only have coverage in the event of an accident/trauma. Mom's insurance is Blue Advantage Administrators of Arkansas. Does anyone have an idea of how I can find insurance that will cover this? Badgercare in the State of Wisconsin is a no go as I am over-qualified for that welfare program. I've looked at Quartz and that Dean's Healthcare(not sure what the name is) insurances but according to their summary of benefits, there is no coverage for this type of surgery.

Here is what the orthodontist and the Dental specialties department diagnosed myself with and what their plan is for fixing my dental issues:

Summary of Diagnosis:
-----Patient has vertical maxillary excess, mandibular hypoplasia, apertognathia, and dental crowding.
-----Plan:
(1) Orthodontic treatment to level, align and remove compensations
(2) Removal of third molars (#1, 16 and 32)
(3) SARPE, LEFORT 1/ BSSO Osteotomy
(4) Finishing Orthodontics
-----M26.01 Maxillary hyperplasia (Vertical Maxillary Excess)
-----M26.04 Mandibular hypoplasia
-----M26.220 Anterior Open Bite
-----M26.31 Dental crowding
-----K08.89 Problems with mastication
-----R47.9 Difficulty with speech

Measurements:
Dentition is in fair condition with no gross carious lesions. Third molars are present.
There are incisor compensations related to the skeletal growth anomaly with maxillary incisors proclined and mandibular incisors retroclined
Maxillary incisal opening 58 mm.
Protrusive 7 mm
Excursive movement to the right is 7 mm and to the left is 7 mm.
Maxillary midline is 2 or 3 mm right of the facial midline.
Mandibular midline is 2 mm to the right of the facial midline.
There is 3 mm of central incisor tooth show at rest.
There is 5 mm of tooth show at high smile.
There is 0 mm of/ no gingival show at smiling.
Severe crowding is present in the maxilla.
Severe crowding is present in the mandible.
Posterior crossbite is not present on the left or right.
Anterior open bite is present.
Overjet 10 mm
Overbite 70%.
Mallampati class III
CR=CO

Skeletal & Soft Tissues:
There is a normal mandibular plane angle.
There is a flat/negative occlusal plane angle.
There is no obvious maxillary yaw deformity.
There is no obvious maxillary cant deformity.
There is no mandibular asymmetry.
Chin point about on.
Mandibular incisors hit the palate

Upper lip length 23 mm .
Alar Width 32 mm.

Here are the codes for the procedures:
21142-52, 21141, 21196, 41899 and 00170

Thank you for anyone that could help point me in the right direction.

[snapdresser]

I’m not familiar with any of those insurance plans. If you search this forum, however, you’ll see that many folks have been approved for treatment with the big national plans, if you have access to them, such as Blue Cross Blue Shield. Good luck!!