pre-existing condition and what insurance to get

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#1 Post by **mexicanlatino19** » Tue Sep 07, 2010 6:31 pm

i have pre-existing condition maybe, let's get that out, now what?

i heard it all, insurance denies and so on so i don't need to hear it again, i want to hear the solutions what to do?

also which insurance plan covers tmj jaw surgery?

kasier? blue cross? aethna? lots of research
but right now i dont have insurance and dont know what to pick

i just want to pick one, have the surgery and keep paying the monthly preim. until a few years, then get a job that has insurance and then drop my private insurance.

#2 Post by **mexicanlatino19** » Tue Sep 07, 2010 7:23 pm

also do i look for hmo or ppo plans? I found some off googling "low income insurance" and found

clear protection 5000 blue cross

vital sheild 500 blue shield

honestly with the whole numbering, what do i pick?? thank you save me time please.

#3 Post by **mamaneedsanewjaw** » Thu Sep 09, 2010 2:49 pm

Well that is the million dollar question! Wish there was one good answer but there isn't. I have heard Kaiser is the best for this surgery. The other major insurance companies have different divisions within them so it just depends on your personal coverage. For example BCBS had BCBS of Michigan, BCBS of Ohio, and so on and so on and they all have different things that they do/do not cover.

I know, not a good answer but there really isn't one that I am aware of.

Good luck to you!!!

#4 Post by **geordie999** » Thu Sep 09, 2010 7:51 pm

My ortho recommend Kaiser - said they cover everything but it has to be done through one of their hospitals. I was covered with Aetna - through work - but also had everything covered.

#5 Post by **Rodney008** » Thu Sep 09, 2010 9:55 pm

I have BCBS for Federal Employees and it is covering everything. It was a hassle, but we got everything authorized. For me, if insurance wasn't going to cover it, another option was to go to a local dental school. I know....I know.....you're thinking it'll be some student operating on you. Not the case. The school by me is the Baylor School of Dentistry, and only the best surgeons are there teaching. They operate on you and use you as a teaching study for the students. It is a slow process but it is all FREE! Just another thing to think about. Good luck!

#6 Post by **schwin** » Fri Sep 10, 2010 4:48 am

Rodney008 wrote:I have BCBS for Federal Employees and it is covering everything. It was a hassle, but we got everything authorized. For me, if insurance wasn't going to cover it, another option was to go to a local dental school. I know....I know.....you're thinking it'll be some student operating on you. Not the case. The school by me is the Baylor School of Dentistry, and only the best surgeons are there teaching. They operate on you and use you as a teaching study for the students. It is a slow process but it is all FREE! Just another thing to think about. Good luck!

I also have Federal Employee Blue Shield, it took 3 tries to pre authorize...they gave me 6 months which end in early December so I'm getting my models done in 10 days and to see if I'll be ready by November. Do you have basic or standard? I have basic and there were no IN-NETWORK surgeons performing this surgery so I'm worried they won't cover it all...

#7 Post by **Rodney008** » Fri Sep 10, 2010 8:59 pm

I also have BCBS Basic. Both the surgeon and the hospital are in network. BCBS at first wouldn't give me an answer if it was covered so my doctor just sent in the pre-authorization paperwork with a fake date. They certified it. So far the only thing I know I'm out of pocket on is $200 for the 2 surgeons, plus the $150 per day in the hospital. I know BCBS will pay the anesthesiologist the plan amount, so I'm expecting a bill for the difference there. But usually once you talk to them they'll just take the plan allowance. Are there any other surprises that you may know of that I might be missing?

#8 Post by **schwin** » Mon Sep 13, 2010 5:04 am

Wow! that sounds promising. It sounds like you had in network oral surgeon because there are none under contract with BCBS here in Indianapolis so I had to get an exception. I'll keep you posted when I get a date for my surgery and the "estimate" . When is yours?

#9 Post by **Rodney008** » Tue Sep 14, 2010 10:17 pm

I have a consult on the 20th, so I should have a date by then. I'm pretty sure it'll be this year. I'll keep you posted.

#10 Post by **schwin** » Wed Sep 15, 2010 11:57 am

Haha nice! well my models will be taken on the 20th and consult will follow. quite nerve racking! How long are you looking to take off? I'm planning 3 weeks...

#11 Post by **Rodney008** » Fri Sep 17, 2010 9:14 pm

Probably the same. I might be able to work from home for a while, but we'll see.

#12 Post by **schwin** » Mon Sep 27, 2010 5:43 am

Rodney008 wrote:I have a consult on the 20th, so I should have a date by then. I'm pretty sure it'll be this year. I'll keep you posted.

Did you get billing worked out? I just got a surgery date of Nov 29, but they can't give me any estimates...GREAT! I have no clue what they will pay since I did get an exception within 6 months.

#13 Post by **24braceface** » Tue Sep 28, 2010 12:01 am

Given the current crappy state of the American economy and healthcare system, I don't think you can get insurance if you have a pre existing condition unless you are a child (Obama's healthcare plan has kicked in for children with pre existing conditions).

Your best bet is to get a job that offers insurance. Places like Starbucks give their employees insurance and there are many other jobs out there as well that offer insurance even for part time employees.

Speaking of Obama's healthcare plan, another great thing is that you can be on your parent's insurance until age 26 now. So if you're under 26, perhaps you can use Mom or Dad's insurance..good luck.

While we're on the subject of insurance, does anyone know if Obama's new plan that kicks into full gear in 2014 will cover procedures such as jaw surgery?

#14 Post by **Rodney008** » Fri Oct 01, 2010 9:22 pm

Surgery date is 11/3. I pretty much know I'll be out of pocket $200 for the surgeon and asst surgeon plus the $100 to $150 per night at the hospital. I'll also have to pay out of pocket for my chin implant since that is considered cosmetic. Total should be around $2,000. Not bad!

#15 Post by **schwin** » Sat Oct 02, 2010 6:19 am

Wow Rodney thats good news. I'm BCBS Basic also, did you have any in-network Orthongathic surgeons or did you have to get an exception?