Jaw surgery insurance reddit Make sure the insurance doctor who reviews the exemption request is a qualified board certified maxofacial surgeon. my jaw surgeon works with my orthodontist and together they figured out what it would take to get surgery to improve my bite. This approval allowed me to start braces (Ortho wanted to wait for the jaw surgery insurance approval before starting treatment), and everything seemed to go smoothly. It is a covered benefit, but the insurance stated it was not medically necessary, despite having tried several less-invasive interventions. Therefore, expect to pay the entire procedure cost out-of-pocket with no help from your insur for anyone else that is looking to switch to Kaiser for surgery, Kaiser only has HMO plans. Share Add a Comment. Had my Surgery August 2nd, 23 days before I turned 21. This all varies a LOT by hospitals, though. Or check it out in the app stores Jaw Surgery + Dental/Medical Insurance . The second surgeon, the one I'm actually seeing, only charges $19k for the same procedure and will bill insurance before taking payment Double-jaw surgery with major jaw advancement and segmentation. Or check it out in the app stores   have a asymmetric jaw, will insurance cover it? After jaw surgery, subjects were perceived to be significantly more dominant, more trustworthy, more friendly, more intelligent, more attractive, and less threatening. Doesn't matter if it's medically necessary, there's a special clause in the policy that excludes all jaw surgery for malocclusion. Because there is so little information on this online, I wrote the first-ever guide on how to get jaw surgery approved by insurers. I’m also My united healthcare insurance still likely won’t cover it, however. I am on medicaid now, mine was covered this way but medicaid only covers this procedure if the surgeon believes it is medically necessary. I am in the process of signing up for health insurance (Cigna) through my full-time job. David Alfi . Join the FB Jaw Surgery Support The orthodontist made the referral to a surgeon and recommended surgery, and the surgeon agreed immediately and discussed different options with me. Usually it's $20k for everything but hospital fee. Get app Get the Reddit app Log In Log in to Reddit. Be the first to comment Double jaw surgery 6 months ago & 1. I have both BUPA health and dental insurance and I am exploring options for jaw surgery. i also have private health that is about $140 a month that will help cover my hospital stay, theatre and part of my As a matter of fact, I did not but I have crazy great insurance that basically covered everything (Blue Shield Blue Cross of Illinois - PPO through my husband's work). The orthognathic surgery falls under medical insurance, not dental. I’m getting double jaw surgery for severe sleep apnea, I have a pretty bad overbite. At this point I am willing to switch health insurance providers. This means that my A few months ago I contracted a medical insurance, my maxillofacial said that he handled insurance but usually by reimbursement, that is, that the insurer reimbursed me the cost of everything. Will insurance cover a Get the Reddit app Scan this QR code to download the app now. So I check my Cigna oral surgeon list and find a few well known surgeons (e. I never directly contacted my insurance company. I plan on keeping a running tally of all the medical bills. Fast forward im 26 with a He offered SARS or double jaw surgery, saying the results would be far better and I went with djs. I have also been diagnosed with sleep apnea. The last picture is not me is similar to what they did to my face. It should be possible to do surgery to expand the jaw to make room for all the teeth. This includes obstructive sleep apnea, bite issues, TMJ disorders, and skeletal discrepancies. Insurance is United Healthcare. Even if UHC denies your case and your surgeon (or maybe you) think you have a chance, you can have your surgeon resubmit your file again and again, you can even find a new surgeon in network that you believe can help your get approved. And braces were $5k, but that’s never covered by insurance. Crypto A couple of years ago, I got 4 consults with jaw surgeons, and even got my insurance to pre-authorize MMA surgery through one of the surgeons, Dr. From reading both the membership guides, it doesn’t sound like the dental insurance would cover the surgery, but I’m unsure about if health insurance covers it. With any surgery, make you get a doctor who can help make you look better. Most of the top surgeons are out of network with most. Same with the pulmonologist and sleep study, also health insurance. It'll be covered by medical insurance. Once I nailed down a surgeon in network, they contacted my insurance company / sent letters etc. He gathered everything he knew he would need to make the claim. We signed up for the gold tier plan at the start of 2020 anticipating I'd be having my surgery sometime that year and also contributed money to an HSA account for the plan. Surgeon fees about $17k. 5mm of shortening with some advancement as well. It makes it really hard to get jaw surgery without insurance because You should not accept that you will never be able to afford it! Ive been recommended to get jaw surgery since I was 18. Insurance should cover the hospital related costs. Most surgeons will not even begin that unless you've also began orthodontic care. It only took 5 days for it to break me. Everything is much more advanced these days, the risk of nerve damage is still there but significantly less common then from when those articles were written. I got so far into the process as to get a surgical plan submitted to my insurance in 2008. The surgery and surgeon will not fall under dental insurance, they will fall under health insurance. I realize now i should have looked into the jaw surgery from the beginning but i was deluding myself a bit into thinking ortho treatment would fix everything. I recognized this as an extremely common thing, where people get surgery with braces, so I figured insurance would just cover it. Hey everyone, just wondering if anyone has tips on how to get jaw surgery covered by insurance. 9 months ago, I saw an orthodontist, who referred me to an oral surgeon, and I was approved for both upper and lower jaw surgery by Priority Health. you may be out of pocket for braces. They’ll let you know what to expect. are all dental procedures covered by dental insurance. Unfortunately my surgeon charged 25K and such Im responsible for the remaining 15K. This is an American problem, obviously. The surgeon then did all the insurance approval stuff. I would recommend looking into insurance coverage in your state or getting the surgery done where you have insurance. I couldn't be more wrong about this. My surgeon was clear that I need to make the decision to have this surgery, and that while he won’t tell me I need it I am definitely a candidate for jaw surgery. However the best surgeons won’t be in network, so insurance probably would not cover the entire cost. I have to call in tomorrow to know why but my guess is the medical specialist from the insurance company denied it thinking it wasn’t medical. This doctor does other things like wisdom teeth, implants,- and to add on top of it his office was dingy and he performs jaw surgery at a hospital rather than a surgery center. Don't read yourself crazy. I'm really glad to have Kaiser as it gives me access to surgeons that do this surgery routinely and it's 100% covered. I'm 9 months post op and really pleased with my results. Hi everyone. Get the Reddit app Scan this QR code to download the app now. Without insurance, I was told the cost for the surgery would be $48,000 and the ortho $7,000. 5k. For those who had a consult or received double jaw surgery at LACOMS, how much were you quoted for everything (anesthesia, surgeon fees, hospitalization, etc)? I need revision jaw surgery as my first surgery left me with functional and aesthetic problems. They were also perceived as happier and less angry, less surprised, less sad, less The easiest is Kaiser. GameStop Moderna Pfizer Johnson & Johnson AstraZeneca Walgreens Best Buy Novavax SpaceX Tesla. Write a letter stating he is the only qualified surgeon in your area. My work suggests that the QHDHP (qualified high deductible health plan) is the best option for my situation, being overall healthy but having a massive surgery for Check for Additional Benefits: Some insurance plans may offer additional benefits or resources related to jaw surgery, such as coverage for orthognathic surgery or access to specialized providers. Double jaw surgery with genio. (Im thinking I’ll likely need lower jaw surgery). The insurance when I first started did cover the braces, and I went into it knowing I had to get surgery at some point. now im 19 and theres barely a difference 😭 cosmetically my jaw looks terrible and functionally my jaws are misaligned and if i push my lower jaw out none of my teeth touch except the top and bottom front 2 These values will vary widely based on what the surgeon charges and which hospital is used. I had full feeling and sensation in my face within a couple days (typically takes many months) and felt like I could go back to work after a week or so (typically takes 3-6 weeks). Definitely talk to an orthodontist and a surgeon. Major expenses were mostly covered but I’m not a professional, but that doesn’t make sense to me. If you are pursuing jaw surgery for known or suspected sleep problems, consider a WatchPAT sleep test, available online for about $200, which is far cheaper than my hospital-provided You have to look at what your insurance deems as medically necessary for jaw surgery. A surgical procedure may be deemed Has anyone suffered permanent nerve damage or had long-lasting pain? Do you feel the benefits outweigh the risks? I had a consult with a very highly recommended oral Medical qualifications needed to get jaw surgery covered, and what you need to prove specifically. I added that I had TMJ for good measure even though I didn’t have it. I also have some breathing issues with my nose and I get chronic migraines and neck/ back pain. FYI I had jaw surgery when I was 15 years old along with other plastic surgeries over the years. You may qualify for insurance coverage if the procedure is considered medically necessary. I do not have health insurance. I’m also going to have to pay about 5k out of pocket for the surgery. Your surgeon's billing department should actively be working to get the surgery covered by insurance, if the not sure if you got an answer yet. Insurer says they’re in the right - since these are “prevailing rates” for double jaw surgery. Implants, bone grafts, crowns, etc. I’m overwhelmed by the price. S) Trying to get state insurance to approve my double jaw surgery. The guide contains: Medical qualifications needed to I am about to get a new job and will have a lot more options for health insurance plans and am looking for specific ones (probably a PPO) that will let me use out-of-network coverage to cover these expensive surgeries. If you're in the US it's more likely that health insurance will cover it. My double jaw surgery is planned for around January 2024. Insurance covered the hospital and anesthesiologist but it was still roughly $50k out of pocket, so it wasn't cheap. And yes, I had a sleep lab test and have sleep apnea and the doctor signed off that surgery was needed in my case. In the US: Surgeon fees can vary from ~$4k-$10k for standard/young OMF surgeons, but can go well over $100k for some of the more famous/experienced be surgeons. Best Insurance Providers for Jaw Surgeries . She assured me insurance would not be an issue because she works with someone who accepts the same insurance she does. I was able to get my insurance to cover my out of network surgeon as in network through network adequacy. Originally, I was supposed to get a double jaw surgery, but as I had to postpone my surgery date by a year, the braces were able to work for longer. :) I’ve looked at the insurance’s policies online however, and they include sections on jaw surgery with conditions that must be met in order to qualify for coverage. But yeah you are right, because we have the NHS private insurers can be pretty painful to work with. ) except for the surgeon fee. Body dysmorphic is a mental disorder and is only treated by mental treatment so obviously you can’t get cosmetic treatment as medical treatment for body dysmorphic, cause that would only feed the dysmorphia He doesn't perform double jaw surgery as his primary job and has not done as many SARPE and double jaw surgery procedures as LACOMS. Congenital abnormalities, pre-existing conditions - there are all kinds of specific exemptions from coverage which can save them a lot of money if they only have to cover changes which Basically i don't think insurance will cover the cost of my jaw surgery because it's already a pre existing condition. Ok so, you will have to do Ortho anyway even with jaw surgery. Compare Costs: Compare the estimated out I'll let you know! I just got a third opinion from an orthodontist who thinks they can use tads, buttons and bands to avoid oral surgery! All of my orthodontists told me to bring the insurance document I shared to the oral surgeon. Fortunately, my health insurance didn't try to weasel out (though they did deny my overnight hospital stay at first) and covered it under medical reasons so I'm going to pay my out of pocket max $6. So this was send to the insurance company and guess what they don’t wanna cover my orthodontist treatment before i can get the jaw surgery. Make sure you do your research on your surgeons and you will be perfectly fine. They were also perceived as happier and less angry, less surprised, less sad, less Hello I just got done having upper jaw surgery and to say the truth no pain and I can still talk/ drink water . Jaw surgery is performed on a daily basis. My orthodontist said if this surgeon doesn’t work with my insurance, he’ll Get the Reddit app Scan this QR code to download the app now. You’re right, cause with dysmorphic you can’t fix it by changing your body, the bdd will find another thing to fixate on. TMJ surgery is a different procedure entirely. Yes I’m in the US. My surgeon's policy was that once the insurance denied it, it was up to me to appeal. Happy open enrollment to all those who celebrate. Internet Culture (Viral) I had a referral from an orthodontist to a jaw surgeon. Or check it out in the app stores Anyone here who had or have double health insurance for jaw surgery? Locked post. Before the surgery, I will also need orthodontic treatment to reposition the teeth. I can barely come up with the money for the orthodontist, let alone another $30,000+ for the surgery. You’ll first need pre-authorization for the surgery with your insurance, and than you’ll need to file a gap exception which means only LACOMS can do this surgery so you’re asking your insurance to make them in network. Insurence will cover all hospital fees so long as you have the correct cover and you just have to pay a gap fee (~$250 -$500). I’m holding off until I can see if the insurance I’ll choose will be more likely to cover the surgery. The entire procedure includes 14-16 months of braces & getting my wisdom teeth pulled before the surgery. I luckily found a surgeon January 2021, and only had braces about 6 months before my surgery since I turned 21 in August. Jaw surgery also known as orthognathic or-thog-NATH-ik surgery corrects There’s a book on how to fight your insurance. jaw surgery is a medical procedure so it is the jaw surgeon who decides if you are a candidate and I did not have the surgery but it was medically necessary and my first submission was denied but then it was approved when my surgeon's office spoke to them. Or check it out in the app stores I'm an expert in getting insurers to cover jaw surgery, and I'm writing up a long post on this given that many patients have these types of questions and the whole process is so ambiguous. A sleep apnea surgeon and an ENT confirmed that I heard back yesterday that my insurance did not approve my initial request for upper and lower jaw surgery. my ortho told me that it’s a real pain in the ass for any insurance to cover this. I am 9 days post-op. g. Where do I go from here? I’m seeing costs of 40-135k I live in Oregon and am willing to travel assuming I can find an lefort 1 osteotomy bilateral sagittal split osteotomy. The first surgeon I was serious with cost $35k and wanted half up front before the surgery before they billed insurance. It’s their system to take advantage of people that can least afford it. However it was only covered to the amount that the insurance company wanted to pay (about 10K). But it can get fully/almost fully covered in the US by insurance when deemed medically necessary. Walline at LACOMS. I am currently 24 under my parent's health insurance. Have functional issues such Business, Economics, and Finance. They will provide pictures and x-rays. He is super caring and attentive. I did get the pre-surgery authorization from Cigna, so all I'm left with is the balance billing Get the Reddit app Scan this QR code to download the app now. and in adults, there might be a chance I might have to get jaw surgery. Cosmetic jaw surgery is never medically necessary. Do you know what plan that is? It’s confusing because under medically some will say 8,000 out of pocket which I am assuming Or your orthodontist to see an oral surgeon who provides corrective jaw surgery. If you are concerned about insurance coverage, keep in mind that you will need an oral and maxillofacial surgeon covered by your medical insurance. I already been to a orthodontist to talk about it but honestly, he wasn't no help at all and i left and went to another orthodontist and I'm now on a waiting list to get my wisdom teeth removed but they're a private dentist and My oral surgeon agreed to apply for preauth before I get my braces put on for peace of mind, though he also said that generally insurance will approve as long as it’s not excluded from the policy and it’s medically necessary. in order to determine coverage. Since there were no in network surgeons nearby, insurance let me pick whatever surgeon I wanted and they’d cover it as in network. The insurance company gets sneaky and get doctors who are different specialities and deny the claim because they lack the domain knowledge. delta dental ppo may cover up to $1000 for braces but check your plan. Didnt have good insurance then so couldnt go to good surgeons so I postponed it. I haven't talked to my ortho about this, but he Context: I'm a jaw surgery patient who fought my health insurance company to cover the surgery, and now I help other patients get their jaw surgeries covered. Internet Culture (Viral) Amazing I’ve heard Kaiser is the best insurance to have for jaw surgery because of the Two OC orthodontists said this to me and recommended that I get KP for jaw surgery. I've been thinking about getting jaw surgery for a long time (recessed mandible is the main issue) but have been put off by the cost. I have a Cigna PPO plan. but your actual copay/coinsurance will vary depending on Does Insurance Cover Jaw Surgery? Yes, insurance may cover orthognathic surgery. I know the best thing to do is review policies and talk to representatives—which I am doing—but there's always more than meets the eye with insurance. Underbite/crossbite- 6 weeks post op from upper jaw surgery. I'm trying to pick the insurance most likely to approve my surgery. Have had five consults and all said jaw surgery would be beneficial in my case. My experience has been completely different, but my Ortho works directly with his team regarding my records. 5 years of braces. As much as one can look forward to jaw surgery. I am now 35. I’m currently in the process of booking an appointment with a surgeon so I’ll see what they have to say. Generally, insurance companies will cover medically necessary procedures; however, if your jaw surgery is mostly for cosmetic purposes, you will realistically have a more difficult time getting it fully covered. I’m not a big fan of Kaiser in general, but for jaw surgery I switched to them for this specific procedure. My oral surgeon and I filed a level I grievance with BCBS (NC) for orthognathic surgery and now they are agreeing to cover lefort I but are denying BSSO Right now I’m on my parents Medi-Cal plan, and from searching on this subreddit it doesn’t seem like there is a lot of information about what they are likely to cover. i know i choose to opt out for many reasons due to my health, my anxiety, and my fears as well as not being very comfortable with the surgeon i was assigned to. I didn't want jaw surgery but after braces, I had an extreme underbite so I didn't really have an option. I live in Auckland. To my utter shock, my health insurance has approved the surgery and hospital stay, which I didn’t anticipate at all. My parent has United Healthcare. It differs between insurances and insurance plans. This was because my surgeon was out of network. Yes. cost of jaw surgery depends on country, health insurance, and which surgeon you go to. And my surgeon, Tehrany, told me during consultation that the surgery would be medically necessary and that she expects KP to cover it. Feeling a bit discouraged, but the surgeon is going to work on an appeal. 100% covered by my insurance without copay. Now i want to start gathering opinions. Or check it out in the app stores How to get surgery covered by insurance? I'm 25M I have a recessed jaw, I wouldn't say it's the most recessed, but it is definitely recessed. but after braces my upper and lower jaw dont fit together at all (necessary to stabilize my jaw and make my The only way to find out if insurance will cover your case, is to go to a jaw surgeon and get surgical planning done. My friend had jaw surgery and aesthetic wise, it didn't improve her but she went through a lot of pain. With open enrollment I am thinking of selecting a new plan. Fast forward to after the surgery, the insurer is only paying around 3k, leaving the remaining 18k bill on me. You can absolutely do a genio on your own with jaw surgery and it's a lot cheaper, and nowhere near as intense of a heal time as long as there's no complications (although they do happen like with me). upvotes Yes, jaw surgery is a medical procedure covered by health insurance. they all cover the surgery. Pre-surgical fee can also be covered by insurance but require extras cover. Total bills, insurance discounts, and out-of-pocket costs. Advice for me Hello, im looking to get jaw surgery in the future and was wondering what your guys’ experiences were with specific providers and which insurance company do you think wouldn’t try to avoid paying for the surgery. Good luck with your Invisalign and surgery! I consult with three surgeons in April so hopefully they agree that surgery is needed. Expand user menu Why do dentists/surgeons treat me as though seeking approval for jaw surgery is the same as seeking illegal My first consultation with the oral surgeon I simply told him my ortho recommended me for surgery to fix my bite. They healed me well, so only the lower jaw had to be operated on. You can call them or you can read it on their website. Insurance companies have specific criteria to determine if it should be covered or not. Also, jaw surgery is often accompanied with a genioplasty. was super stressed for ages that it wouldnt be covered, especially because my sleep study results were weak. Why do dentists/surgeons treat me as though seeking Get the Reddit app Scan this QR code to download the app now. What would be the best way to get Luxembourgish insurance coverage on both treatments (orthodontic + jaw surgery)? I'm in my 20s, so everything concerning insurance is new to me. Just helped my face became symmetrical and fix the reset chin. A little about me: I have a very clear recessed jaw/chin. I guess they think this is for fun lollll So I'm set for a pre-surgery consultation to determine a surgery date and go over the details of the procedure with my surgeon in one month. Meeting with him was encouraging and I’m looking forward to the surgery. My son needs both upper and lower surgery and our crappy insurance won't pay. I have mild apnea, I got a UARS diagnosis, and my jaws are recessed a bit, and I have a steep angle for my lower jaw. For those that had surgery with Dr. My oral surgeon only accepts BCBS and a few months before my surgery, my employer switched us to United. I decided to not go through with that yet. If there are no providers in your area who take your insurance, look into network adequacy. Today I went into ER for severe dehydration. There are plenty of good surgeons that take insurance, and the majority of Americans who get jaw surgery are not rich and do not pay $70,000 out of i feel sick to my core. The CPAP helps but not enough, I still felt tired and sleepy during the day. I called and my health insurance does indeed cover jaw surgery if it is medically necessary. I have Kaiser and in Southern California if that helps. To give you an idea of my case. 🤷🏽‍♀️ hey! if i were you, id get a couple second opinions from other surgeons. I am a full time nursing student so I didn't have health insurance to fall back on so I've decided to go down the route of marketplace insurance and decided on a BCBS EPO plan (I assume this will suffice as compared to others the 600$ My appeal documents were 110 pages which included research on the benefit of my surgeries, surgeon plan and opinion, chart notes, swallow study, medical history dating back to 2012, a collection of 200+ cases where insurance paid for surgery for people with similar issues I had prior to surgery, and mismanagement by BCBSNC which all supported Can I get some guidance from experts here. I got the CPT codes from my surgeon and called local hospitals to get estimates. even though there are risks involved (as there is with any surgery), it was totally worth it for me. My question is two part. The benefits include preventing wear on certain teeth, sleeping better, preventing jaw pain, and it will also help me breathe better. Or check it out in the app stores Home Best insurance for jaw surgery? Looking to get some input as I want to begin the process of getting jaw surgery soon. I say "may" because it depends on whether your plan covers adult orthodontics. Or check it out in the app stores I had a consultation with the jaw surgeon that my orthodontist recommended, and the quoted price for double jaw surgery was $26k. I will have Kaiser next year as I’m going to be off my parents plan. It’s called approved by Laurie Todd. I’ve had 2 Jaw surgeons and a sleep specialist tell my insurance that my lower jaw is recessed far enough that it impacts my breathing causing sleep apnea. You need to ask for an out of network exemption so they cover in network with a top surgeon and also focus on New York or LA because those are only the major cities that have the highest fair For those of you who have gone through the surgery and treatment how has your experiences with insurance and payment been? r/jawsurgery A chip A close button. My jaw problems cause me pain and chewing issues, and likely sleep apnea. Supposedly United is tougher on approving this type of surgery. After jaw surgery, subjects were perceived to be significantly more dominant, more trustworthy, more friendly, more intelligent, more attractive, and less threatening. I received an itemized bill and the largest line items were anesthesiology/hospital stay. Surgery would happen about 9 months after I get Anyone have experience with having insurance deeming “medically necessary” for jaw surgery but with an out of network provider? Were you still balance billed after your insurance allowance was paid to the provider? Hi, just wondering if anyone here got insurance coverage for a jaw surgery for Upper airway resistance syndrome? The in-lab sleep study I did showed the AHI of 1. For context, I'm having surgery with Dr. Dale Stringer. I will note, however, that my surgery recovery process was very positive; I never had issues with pain, my doctor was receptive and able to meet with me at any time to discuss my concerns, and little to no surgery-related hiccups during recovery. From my consultations and research, Kaiser seems to be the “best” when you factor in surgeon skills AND costs. My lower jaw is still heavily recessed, asymmetrical, along with an overbite and overjet. Passenger in a fatal car crash at 18 now 39 and having jaw surgery. I have tmj and an asymmetrical jaw. For people who seem to be having dysmorphic concerns, making these suggestion just contributes to Get the Reddit app Scan this QR code to download the app now Funding Jaw Surgery costs in Europe, Health Insurance vs EU national health reimbursement . would insurance coved jaw surgery for a severe overbite? ive already done braces twice, double expanders, and a herbst device. David Alfi; were you able to get your insurance to cover the procedure? How much assymetry improvement could I get/should I go through with jaw surgery The cover is confusing but to summaries there are 4 charges for the surgery: hospital fee, pre surgical fee, surgical fee and anaesthesia fee. Internet Culture (Viral) Has anyone had any luck with state health care/crappy health insurance covering jaw surgery ? I definitely have issues with my jaw that would be deemed medical but I wanted to know if it’s even Get the Reddit app Scan this QR code to download the app now. I’ve been told some insurances are more stubborn than others. Be aware that DJS won’t directly address TMJ (per my surgeon). had i waited a year longer, they would’ve had to do my djs and tmj surgeries Has anyone been successful with an appeal or grievance to get their insurance to cover their surgeon fee? I recently had corrective jaw surgery. Let me tell you, the pain and hunger are a real struggle. KP member services told me that the determination for whether surgery is medically necessary is from the surgeon. the First, you will never get your health insurance to pay for orthognathic surgery when the procedure is cosmetic: reshape or enhance the size of the chin to restore facial harmony. 4, but I had no rem sleep and I usually have larger AHI according to my CPAP machine. My insurance covered most of the expense (hospital, MRI, etc. Personally for me it is life changing even if no one can point it out. My surgeon wants me to get braces first, but the quotes I’ve gotten are 6-7k. Or check it out in the app stores Im only doing jaw surgery if my TMJ problems become horribly wrong or I actually get severe sleep apnea in the future And a CPAP Hi! I have Cigna insurance and I've been fighting for 6 months to have them cover more of my surgery. My insurance has deemed jaw surgery “not medically necessary” even after 2 appeals. For example, my surgeon said that he wouldn't even submit a claim for an extraction, and if I needed one, I'd be out-of-pocket for it. It has been 5 days since the surgery. So long as you have proper documentation and imaging. I called my insurance and asked this and all they told me was that the surgery needed prior authorization to be covered. $7,600 for invisalign, $11,500 for the surgery, plus hospital fees for an overnight stay. S. heya! i'm getting jaw surgery done in victoria - it's costing approx $10k ish including anaethetic, surgeons cost etc. You will need to ask your surgeon what the policy is on the case of needing a dental procedure, like an extraction, during surgery. Hi, I am currently recovering from a lower jaw surgery. All insurance needed was scans and pictures. Thank you! Posted by u/mcnoobles - 2 votes and 4 comments This is for all those who are getting their jaw surgery through Kaiser. , Alfi), but when I call the surgeon’s office, they tell me it will only cover the hospital and anesthesiologist and his fees are not covered. They said this was something that the jaw surgeon office will submit to them and they will review and deem it medically necessary or not. i’m in massachusetts with masshealth. My medical insurance should cover the surgery and my dental insurance is giving me a discount on my ortho. If you are gonna talk so much about a topic you obviously have no idea about, you should really do your due diligence first, because your comment However, I’m worried about if the jaw surgery will be covered or not under my insurance. Please list the cost without insurance and your surgeon. You should make sure your surgeon is in-network for both your health and Anesthesia another $6-8k. They're able to use that documentation to help with insurance pre approval. That was the last I heard of anything insurance Get the Reddit app Scan this QR code to download the app now. It had removal and replacement of the TMJ in the plan, fwiw. i would just recommend talking to a few other surgeons because i feel Yeah, unfortunately, you might need a different insurance plan. If you are willing to detail the steps of how you were approved for DJS thru your health insurance that would be dope too Fortunately, all my procedures were pre-approved by my insurance, and my insurance actually deemed my surgeon in-network due to "gap coverage" (no surgeon in my local area could perform the surgery). Had UHC insurance who approved the IVRO and Lefort procedures, for a out of network surgeon. This started off as getting my teeth straightened. There are some rare exceptions to this but this is for much more intense stuff than jaw surgery-related conditions, like certain cancers, cystic fibrosis etc. Does anyone with similar symptoms have advice on which issue qualifies you for coverage (im in the US) or what process you had to go Jaw surgery out of pocket can be upwards of $25,000 per jaw at the top surgeons in the country. I was looking at my insurances coverage + benefits, and in the ortho section, it says it does not cover jaw surgery and any For my double jaw surgery, the hospital billed $43k, surgeon billed $30k, and anesthesiologist billed $4k. . They take xrays, sometimes CT scans, or use face bows to determine how The issue is that ever since that appointment, I have been struggling to get my insurance to approve the surgery. After a few weeks my insurance told me that they are unable to cover the surgery despite the surgeon saying that my jaws are very recessed and Work with your ortho office to find an oral and maxillofacial surgeon who performs jaw surgery. Overall, unless you're really having functional issues, I'd pass (and mine was free lol) I had really ugly teeth before but I'd trade it to have 3 years without braces and avoid jaw surgery. unfortunately i doubt you will be able to manage that kind of medical debt without insurance (given braces treatment, surgical operation, hospital night stay is also pricy, cost of medication after op/recovery supplies). ? Why do dentists/surgeons treat me In reality their costs are closer to the $13,000 which is why that is all they charge insurance companies. I would like to hear your experiences, I would like to know how is the process, since I would like to have this option if possible, don't ignore :( I'm from Chicago as well and I can tell you every surgeon charges a different rate. Once I was able to speak to my surgeon's surgical coordinator, she requested I send her a copy of my sleep study results, as it woupd help get the surgery approved by insurance. It seems insurance doesn’t like to cover this surgery :/ My orthodontist referred me to a surgeon, one that she ALWAYS works with. Or check it out in the app stores   It'll depend on your insurance provider. To get an anesthesia estimate, I think you need CPT codes as well as a time estimate from the surgeons office. Or check it out in the app stores He’s willing to write a letter but believes his opinion won’t hold weight with insurance. New comments cannot be posted. I think your surgeon's office will file for insurance. I was told by my insurance that an “in network” surgeon would be covered 100% for sleep apnea. I’m in Michigan. Or check it out in the app stores Jaw surgery is covered by insurance in the U. The surgeon will be the one communicating with Kaiser about coverage. hi I’m curious to know peoples experiences with insurance and jaw surgery. I was already in braces and kinda freaking out that I wouldn’t get my surgery covered, especially because the line of jaw surgery being “medically necessary” is kind of fuzzy in some cases. Hello everyone, I'm planning on getting double jaw surgery in Belgium. the kaiser medical insurance covers the jaw surgery and the braces are covered by dental insurance. Get the Reddit app Scan this QR code to download the app now Using an out-of-network surgeon or a surgeon who doesn't take insurance at all (like a lot of the famous/trendy surgeons) means you'll be paying a lot of money yourself. I absolutely have a special situation, but insurance is covering upper and lower for my overbite for both functional and aesthetic reasons, moving both jaws forward and potentially genioplasty based on the surgeons discretion if my chin still appears weak after the double jaw advancement. I’ve had my braces for a year and a half before the scheduled surgery. 4. Some people in Jaw Surgery Support Group on facebook did like 3-4 times till they got it. I had a consultation several weeks ago and was told I’m a good candidate for upper jaw surgery - 4. Or check it out in the app stores Insurance Covering Surgery With Dr. The only part of this process that may be covered by dental insurance is the orthodontist. Hospital fees include anesthesia ($1-$5k) and hospital facility fees ($20k-$150k). Just go and consult a couple of maxillofacial surgeons. it was only when they were actually working on my jaw that they saw i had a benign growth on one side of my jaw, as well as the beginnings of a tear near my joint. They were very clear at the beginning that they do not take insurance of any kind. I’m concerned that insurance won’t cover for my surgery even though it was recommended by my orthodontist (recessed lower jaw and narrow upper palate). Jaw surgery is not for the faint of heart and diagnosing and recommending legitimate surgical issues/ repairs is the responsibility of actual maxillofacial surgeons. I have sleep apnea and a very narrow airway as well as a deviated septum. because the last surgeon I saw post jaw surgery once I realized things Get the Reddit app Scan this QR code to download the app now (Located in the U. Dr Gunson wants $70,000 upfront for double jaw surgery even though my insurance is in-network. I have consulted with an ortho and an oral surgeon. My surgeon said it’s really rare that Kaiser doesn’t cover jaw surgery if the patient has jaw pain or it’s ortho-recommended. In contrast, orthognathic surgery is deemed medically necessary with an overjet of 5+mm by Anthem BCBS. Edit: now 8 months post-op, and my sleep is totally fine – I seem to have unrelated neurological chronic fatigue from years of sleep apnea, mold exposure, and multiple jaw surgeries. I just can’t afford that even with a payment plan. In my appeal letter to BCBS of Texas the main proof I included was an examination from a speech pathologist who advocated that I had trouble speaking and eating. It is worth noting the Surgeon team was amazing and I’d like to get evaluated by an ortho for a recommendation but I don’t have insurance yet. a girl cannot breath 😭 Any my jaw surgery was $80,000 but bc of insurance i’m only paying $3,000 which is still a lot. I’ve had surgery Tuesday morning at 8:20am and was discharged the next morning at 10am. Life is great. The link leads to another Reddit thread, that is compilation of 20+ threads that has tens of users. Unfortunately most surgeons that I have felt comfortable with during this with have been out of network for everyone. Use Google maps to search jaw surgeon / orthognathic surgeon / maxillofacial / craniofacial. The braces are finally gone! Unfortunately insurance is intended to make profit by finding excuses and opportunities to not provide coverage (as much as they advertise the idea of insurance being there to help). Hi, I had a couple of quetions about funding jaw surgery in Europe and was hoping there are some people who might have experience with private health insurance or claiming EU reimbursements Get the Reddit app Scan this QR code to download the app now I need a total DJS surgery with joint stabilization. I experienced something similar to this. My journey: got a sleep study done to confirm sleep apnea -> moderate OSA -> was on CPAP for 4ish years and it didn’t work -> got turbinate reduction from ENT with mildly improved things -> one year later turbinates regenerated-> went looking for orthodontic device I could wear at night for sleep apnea -> ortho recommended me for DJS instead -> surgery consult -> insurance Thank you!! I can’t wait to read/see more updates. I have an overbite but it doesn’t seem TOO severe (my front two teeth cover about 60-70% of my bottoms. the first surgeon i met with told me that i just needed upper jaw surgery to fix my under bit but the second and third surgeons i saw said that i needed DJS where my upper jaw moves forward a little and my lower jaw moves back a little. Or check it out in the app stores     TOPICS. Soooo i did it!! had my jaw surgery with dr Eren Perena and team from hospita prime clinic in Istanbul at the liv hospital 🏥 crazy pics warning ⛔️ 20. A huge barrier to jaw surgery is financial. Now I'm gonna try CPAP. I only looked into the information for underbites (since that’s what I have) however, and measurements and qualifications for underbites and overbites are a bit different, so I My current current insurance, Credence BCBS (previously BCBS of Alabama) does not cover orthognathic surgery except in cases of birth defects or trauma. Anyways don't take my word for it, your surgeon's office should have someone who handles insurance. Or check it out in the app stores Which Kaiser insurance plan covers jaw surgery? Thank see some say they didn’t pay anything to get jaw surgery. The surgery is covered as long as the surgeon seems it medically necessary. I currently have a really shitty insurance plan through my employer. Of course you may have some benefits to your jaw once they are aligned properly. Context: I have Anthem PPO and got the pre-authorization for surgery. Who knows what kind of amazing result I The jaw surgery will fall under medical insurance. Excellent care. Jaw damaged and now this is my journey My understanding is that as long as there is a medical reason for the surgery such as to treat sleep apnea, insurance would help cover the costs. lfxaea wcrtw rwsxisl ldijhy pkhgdr ejceth opptu hdcva cskqbjic tapm