Author Topic: For those of you who got your surgery fully covered by insurance.....  (Read 2684 times)

hmatt330

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HOW???

This started in one of my other threads and it seems very, very difficult to do so.

http://jawsurgeryforums.com/index.php?topic=6168.0

Is there any way I can get it fully covered by purchasing a policy which a good surgeon is in network in? Preferably in NJ, or at least the tri-state area?


I have been pushing this back and I hate doing so but I am at a complete loss of what to do!


Thank You!
« Last Edit: December 07, 2016, 11:45:56 AM by hmatt330 »

hmatt330

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Re: For those of you who got your surgery fully covered by insurance.....
« Reply #1 on: December 14, 2016, 03:30:41 PM »
Plz help! Really want to get started; does anyone have any idea how to go about this??

ditterbo

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Re: For those of you who got your surgery fully covered by insurance.....
« Reply #2 on: December 14, 2016, 04:09:07 PM »
Yeah I think we're all at a complete loss on this one (hopefully just unjinxed it).

TMKA

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Re: For those of you who got your surgery fully covered by insurance.....
« Reply #3 on: December 15, 2016, 05:03:02 AM »
My surgeon got my surgery approved by providing information showing I had severe sleep apnea. I think they may cover it for TMJ also.

hmatt330

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Re: For those of you who got your surgery fully covered by insurance.....
« Reply #4 on: December 16, 2016, 10:28:42 PM »
great! I do believe I have sleep apnea, albeit minor. Is the ceph enough, or do I have to get a sleep test?

TMKA

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Re: For those of you who got your surgery fully covered by insurance.....
« Reply #5 on: December 17, 2016, 04:50:36 AM »
The more info you provide the insurance, the better. I had my sleep study and the ceph turned in.

Jbird

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Re: For those of you who got your surgery fully covered by insurance.....
« Reply #6 on: December 17, 2016, 08:38:59 AM »
I have severe OSA.  The insurance will cover the hospital but not the entire doctor fee.  They will only cover 10 percent of it, something called usual and customary.  Does not make sense.  No one charges 4000 for MMA.

kjohnt

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Re: For those of you who got your surgery fully covered by insurance.....
« Reply #7 on: December 20, 2016, 04:02:15 PM »
My insurance guidebook specifically states that orthognathic surgery is never covered, so mine isn't paying s**t.  I checked every insurance option available to me by my company and only Kaiser Permanente doesn't have the same or similar language.  Given everything I've read about Kaiser, I'm not going there and I don't want its surgeons touching my jaw.

My insurance will cover the costs of a CPAP machine and they wanted me to go in and get fitted for one, so it isn't an issue of the company not recognizing the need to fix sleep apnea, which tells me it's an issue regarding money.  I don't know how it's legal... perhaps not enough info out there regarding how jaw advancement essentially cures OSA if planned correctly and the gold standard currently being CPAP.

hmatt330

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Re: For those of you who got your surgery fully covered by insurance.....
« Reply #8 on: December 23, 2016, 08:35:01 PM »
this is honestly really, really sad to hear.


Something that's somewhat necessary and life-changing, and should generally be fixed, and we have to shell out >the AVG AMERICAN SALARY just to get it. Unreal

LyraM45

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Re: For those of you who got your surgery fully covered by insurance.....
« Reply #9 on: January 01, 2017, 07:28:52 PM »
Each plan is different, and each plan is different in each state too.  Nobody can really help you out 100% here unless it's somebody in your state with your exact plan and knows the plan already.  Each insurance has different criteria for coverage.  Do you know your measurements?  Most insurance companies want to see at least 5mm discrepancies before even considering this medically necessary.  Or they want to see proven sleep apnea, debilitating pain, limited function that causes loss of nutrition, etc-- and for all of those things sometimes previous measures that were taken to make them better, IE: if you have apnea, did you try a cpap already and it didn't work.  They want to make sure all other options are exhausted.  Your doctor will send in all the required scans and documents with that kind of information to put in for medical necessity with your insurance.