Author Topic: Insurance providers - who is best for jaw surgery coverage (US)  (Read 9840 times)

Alue

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Who, in your opinion, is most likely to cover jaw surgery?  Most of the big insurance providers have exclusions for jaw surgery unless it's an extreme case, for OSA that cannot be corrected with cpap etc. 

A small local provider that was only in my state actually did say they would cover my jaw surgery.  Looking at the exclusions with other health care providers it seems unlikely that many others would cover it. 

LoveofScotch

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Re: Insurance providers - who is best for jaw surgery coverage (US)
« Reply #1 on: August 11, 2014, 07:30:01 PM »
Unfortunately, just as much of an issue is if a doctor/surgeon participates as an in-network provider. Many surgeons are out-of-network with ALL insurance companies. On the upside, sometimes you can get other surgery related costs covered (hospital stay, anesthesiologist, etc.) even if the surgeons fees are not.

I'm extremely thankful for having insurance, but it still sometimes makes me want to commit hara-kiri. I've never run into this, but also keep in mind (I think?) occasionally insurance companies have waiting periods before coverage kicks in.

nrelax11

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Re: Insurance providers - who is best for jaw surgery coverage (US)
« Reply #2 on: August 12, 2014, 02:53:21 AM »
My insurance covered mine even though it was half cosmetic, but mine is Kaiser Permanente insurance and its only in California.  Its a chain of hospitals and I really lucked out because I loved my surgeon and it was completely covered and didnt have to pay a dime.  Well, braces is another story though. I think the only maxillofacial surgeons for my insurance are located in my area (Bay area) and LA. Ive heard a lot of good things about the surgeon in the LA hospital too.

Alue

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Re: Insurance providers - who is best for jaw surgery coverage (US)
« Reply #3 on: August 12, 2014, 09:09:44 PM »
It seems like local insurance providers are more likely to cover it.  Maybe it's also because the surgeon has a good reputation with the local insurance company, they see the name and they are less likely to deny the claim.  United, BCBS and the like seem like they will deny coverage if at all possible. 

I'm just interested in getting as many opinions as I can. 

ticktickatick

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Re: Insurance providers - who is best for jaw surgery coverage (US)
« Reply #4 on: August 19, 2014, 04:05:30 PM »
I've heard Kaisar Permanente is really good about coverage but I think they are only for certain California residents.

Some Aetna plans will cover it if you can really really really prove your bite is absolutely horrible or your TMJ is debilitating and you have exhausted all other options (nightguards etc.).

nrelax11

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Re: Insurance providers - who is best for jaw surgery coverage (US)
« Reply #5 on: August 19, 2014, 08:06:42 PM »
I've heard Kaisar Permanente is really good about coverage but I think they are only for certain California residents.

Some Aetna plans will cover it if you can really really really prove your bite is absolutely horrible or your TMJ is debilitating and you have exhausted all other options (nightguards etc.).

Yea Kiaser is pretty layed back about covering the procedure. Its all up to the surgeon, but like you said, they're only located in California,  Oregon and one hospital in Hawaii

LyraM45

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Re: Insurance providers - who is best for jaw surgery coverage (US)
« Reply #6 on: August 20, 2014, 09:51:12 AM »
Warning-- sorry for the lengthy post, but this is my .02 on my Kaiser experience:

Kaiser is laid back about covering it, but please know that you get what you pay for.  Because they are laid back about covering it, you are walking into a factory.  The surgeon is going to have WAY too many cases to really care about you like another surgeon outside of Kaiser will.  The sheer volume of people they handle really does not allow them to give you the same care you will get at other places, IMO.  That doesn't mean they don't have great surgeons.  Also doesn't mean they don't have crappy surgeons. 

I was done at Kaiser in NorCal and it was a total failure to where I am left with a MUCH worse bite than what I went in to fix and now I need a more complex and complicated revision to fix the things they really messed up.  I liked my surgeon.  She was a nice lady.  BUT, as soon as the crap hit the fan with this, all of the sudden I didn't get the time of day from her.   She wouldn't even grant my request for an appointment to examine me and see what else was wrong and what had to be fixed.  I basically got hung out to dry and now I am forced to find another surgeon to fix me and I'm looking to be $30-70K out of pocket for it.  So far a few of the consults I've went on have showed me night and day what the experience is like with other surgeons compared to Kaiser.  I never got more than 15 minutes with my surgeon, and most of the time it was her residents and not her.  I only had two appointments before my surgery-- one super quick initial  consult, and the other two weeks pre op.  You do not get measurements taken, or shown tracings, projections, or any part of your plan at all.  I asked multiple times for expected movements on my face, and all I got was "well, we're going to move you a smidge here, a little here, and do this and wah-la, you'll be good to go."  I just kept on with that because I had faith in my surgeon (and my ortho who highly recommended her) and figured this is how she's done it hundreds if not thousands of times, so it will be OK. 

The other surgeons I've seen for revision consults.... well, so far they are amazing and it's like night and day.  Some of them have seen me for hours, taken all sorts of measurements, scans, etc, and have already done mock surgeries to tell me what needs to go where to correct all of Kaiser's mistakes.  It made me sad to realize how many corners Kaiser cut when I saw what care I could have been getting elsewhere.  Again, is that because my surgeon is a bad surgeon, or is it because she is just a part of the Kaiser factory getting handed way too many patients and this is the way she has to do business?  Maybe both?  I don't know.  I know there are other people like me who came out like this from Kaiser, but they do a good job at putting a lid on people when stuff goes wrong, so you don't hear about it too often.  I didn't in all of my pre op research on them. 

So, I will say this from my experience-- you get what you pay for.  This doesn't mean you don't have a chance to come out with a good result.  I know people who have come out just fine from Kaiser.  But, I feel like it's a greater roll of the dice with them with the way their system is set up and how patients just don't get the time/care they would get from other surgeons.  Leaves greater room for catastrophic error like my case, and if you're lucky enough to avoid that, then greater room to not achieve the perfection you might have gotten elsewhere.  Best advice I can give to people is go on other consults.  See what other surgeons are like before heading in to Kaiser.  At least you'll have that to compare before walking in to the factory with blind faith.  If you're in NorCal close to the Bay Area, there are a TON of great surgeons here.  Check out the maxfac department at UCSF, Kasey Li at Palo Alto, and another great lesser named surgeon I have consulted with is in the East Bay named Nestor Karas.  There is always Dr. Relle and Dr. Arnette and Gunson down in SoCal too.  There are definitely great choices out here and doesn't hurt to go on consults.

nrelax11

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Re: Insurance providers - who is best for jaw surgery coverage (US)
« Reply #7 on: August 20, 2014, 07:56:20 PM »
Sorry to hear about that :( Are you gonna sue?

LyraM45

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Re: Insurance providers - who is best for jaw surgery coverage (US)
« Reply #8 on: August 20, 2014, 08:19:44 PM »
Right now I am just overwhelmed, consumed, and primarily concerned with just getting fixed.  My bite is so far off and I am in so much discomfort/pain that I am on a mission to find the best surgeon and specialists to help me.

LoveofScotch

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Re: Insurance providers - who is best for jaw surgery coverage (US)
« Reply #9 on: August 20, 2014, 08:40:25 PM »
LyraM45,

Yikes, I'm sorry.

I have not yet had jaw surgery, but I've been around the block a few times with medical stuff (that's a gross understatement). It has been both my experience and observation that what you're describing is the norm regarding how you've been treated. Terrible, right? Again, I'm not specifically referring to jaw surgery, I'm talking about ALL medical stuff.

If it helps, none of this is personal. None. It's rarely personal to the doctor, so if you can separate yourself, I find that helps. This will probably sound messed up, but I treat my health kind of like a business. When I go to a doctor, there are no feelings. Also, sometimes even amazing doctors and/or surgeons leave you high and dry when/if things go to pot.

I really hope you're eventually able to get all this sorted out.

Alue

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Re: Insurance providers - who is best for jaw surgery coverage (US)
« Reply #10 on: September 01, 2014, 03:41:25 PM »
Thanks for the info LyraM45.  Let us know how it turns out.