How difficult was it to get preauthorization?

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#1 Post by **alyssabunny** » Tue Mar 28, 2006 6:15 pm

Hi,

Has anyone had a bad or good experience getting preauthorization? I currently have Premera Blue Cross if that helps.

THanks,

Alyssa

#2 Post by **braces4me** » Tue Mar 28, 2006 6:39 pm

Hi Alyssa-

It really all depends on your policy/insurance. I have United Healthcare and got pre-approved on the first try. I have read horror stories of people that have fought many months to get pre-authorized. My suggestion would be to take a look at your benefit summary if you have it available to see if there is any exclusions for OGS surgery. All insurance companies and policies are different. I deal with insurance companies on a daily basis and know what kind of games they like to play.

#3 Post by **Teigyr** » Fri Mar 31, 2006 1:40 pm

Alyssa,

You could check with your OS. I also received authorization on my first try. I think the OS would be used to dealing with insurance and he/she would know how to approach it. Mine had my file out this HUGE list of questions about chewing and difficulty eating, etc. I never really thought about it because I've lived with my bite all my life and I guess I just thought that's how it is. Anyway, the surgeon's office said that the insurance companies approve more if there is a "real world" problem and solution...ie my life and nutrition is being negatively impacted by my problem. Then, of course, they did their end of the paperwork that had all the medical information and list of future problems I'd have if my bite wasn't fixed.

Another thing to look at is cash price. Oddly enough, my insurance price is $3,000 less than my cash price. The amount billed to insurance was $11,000. I will end up paying $3K out of pocket but had insurance not approved, it would've been $6K. I went ahead with braces before approval because I figured that I'd have a year to fight them and if worse came to worse, I'd pay the $6K.

Good luck!

#4 Post by **alyssabunny** » Mon Apr 03, 2006 11:10 am

Hi Teigyr,

Thanks for the info. Are you having your surgery done in Seattle? I would love to know where other people in the area are going. I do know someone that went to Overlake in Bellevue a few weeks ago and she didnt have any problems post surgery.

Also, are you having anything cosmetic done in addition?

I just found out my insurance doesnt cover a penny but my fiancee's fabulous insurance would cover everything so I am going to try to get on his a little early

I didnt want braces for my wedding so I am not sure how we are going to do this without have a real wedding and a fake wedding later.

I know what you mean about eating. I have never been able to chew on my left side. I think I chew with the sides of my teeth rather than the tops so it would be amazing to be able to eat normally. I cant even fathom having all my teeth touching at the same time and in the right position.

#5 Post by **Teigyr** » Tue Apr 04, 2006 11:22 am

alyssabunny,

I will be going to Roger West. Unfortunately, he's retiring this year! His last surgical cases will be in September. He isn't in my insurance network but since I have an open choice kind of plan, my insurance pays but not as much as it would if he was in network.

No, I'm not getting anything cosmetic. Are you?

It's funny, I will look at my boyfriend and see his teeth actually meeting in the front and in the back. I've asked him what it's like!!! The thought of it is just strange, you know? I bet I'll misjudge when I eat, initially. There might be a lot of relearning.

LOTS of Seattle people here

If you check out the Seattle thread in the off-topic portion, you will see. There are monthly get-togethers, also! It's a great group of people and is a good opportunity to compare braces/surgery notes.

#6 Post by **bsdaluva** » Fri Apr 21, 2006 5:15 pm

[quote="Meryaten"]hola, alyssa - wonder how I missed that you're in the Seattle area too.

My ortho very highly recommends Dr. Audia in Bellevue, but as he's not on my health plan I am going instead with his second recommendation, Dr. Dale Bloomquist in Seattle."

I will be having my surgery done on the 28th by Dr. Bloomquist. I will let you know how it turns out.

#7 Post by **tdjaco** » Wed May 17, 2006 3:26 pm

braces4me,

I am in the first stages of researching oral surgery for my open bite, and I have a question. You said that you got approved by United Healthcare. What specific insurance do you have through them, if you don't mind me asking? Personally, I have United Healthcare Choice Plus POS. When I read through my insurance coverage, it said that they don't cover oral surgery unless the problem was caused from an injury. But if you got approved, it gives me hope that I may be able to get approved also. Thanks