I might be having jaw surgery to fix my underbite in the near future, and if i do, I'll be using my insurance to bring down the cost a bit. Will my insurance company assign a doctor to me, or will i be able to choose? Will it be my orthodontist who chooses the doctor? If it is my ortho who does it, will they choose a doctor based on my requests? I'm very concerned about this, since I'd prefer seeing a reputable surgeon who will take my aesthetics into consideration, rather then some second rate clown who just wants to make a quick buck. Thoughts?
1) If you end up with a surgeon who is "in network" with your insurance company - - AND - -
2) Your surgery is "medically necessary" under the written guidelines in your insurance policy;
Then in theory the insurance company will pay for the surgery less your deductible.
Problem: VERY few of the best orthognathic (jaw ) surgeons are "IN NETWORK" with
any of the insurance companies.
WHY ? Because the re-imbursement rate that the insurance companies will pay are so pitifully low that there are virtually no genuinely skilled surgeons who will do the surgeries for that miserable re-imbursement rate. Some do in some specialties - - but is usually because their practice overhead and expenses are otherwise subsidized (typically by a hospital or a charitable foundation.)
[ Example: Billings for major surgeries ( 7, 8, 10 hour surgeries) that involved jaw and other facial and cranial surgical procedures. The total insurance re-imbursements to the surgeons are sometimes less than $100/ hour. In other cases, the anesthesiologist is making more / hour (with little or no overhead) than the surgeon. Of course, the hospital will get 8 to 12K for providing the "facility" for the surgery. ]
So .... where does that leave you ?
Most of the "good surgeons" that are "out of network" with your insurance company will work with you to some extent. The result is that your insurance company MAY pay part or maybe all of the "hospital costs" (operating room facility and anesthesia).
And maybe - - your surgeon can bill the company and recover for you a very small part of the out-of-network surgeons fee . That may take 90 days or six months or more.
(The "out of network" payments to the surgeon are even smaller than the "in network" reimbursements.)
You may want to find an orthognathic surgeon and make sure he or she can and will work with an orthodontist that is convenient to you.
The better orthognathic surgeons can do the necessary coordination with orthodontists that work in other cities or states from their surgery practice.
If you are already working with an orthodontist - - and you like a particular surgeon - - ask the surgeon if he is willing to work with YOUR existing orthodontist. THEN ask your orthodontist if he is willing to work with your preferred surgeon.
Many orthodontists will likely tell you they often or normally refer to a particular one or two local or regional orthognathic surgeons. Many will ask if you are financially constrained to only use one covered by your insurance - - or if you are able and willing to pay for a private out-of-network surgeon.
The orthodontist may then have alternative suggestions based on the financial circumstances. Or your orthodontist may be perfectly happy to work with the surgeon of your choice.
Hope this helps.
PS. Yes. This is a very screwed up, complex, and unsustainable "system". But it is, at present, what it is.
