How to get insurance to cover Jaw surgery?

[FreshPrince]

I have an Extremely bad overbite/openbite. I can stick a pencil through my openbite. I talked to my insurance today and said they will only cover it if its a medical need. So my ortho is going to have to send them a letter convincing them its a medical need. I will be talking to him about that in a couple days. So what can i say or pretend i have to get insurance to cover the surgery?

[smylex]

So what can i say or pretend i have to get insurance to cover the surgery?

It's not what you pretend you have that will help you - it's what you can prove you have to show why this surgery is a necessity. Pretending to have symptoms to get coverage for something that could easily be corrected by other, often less extreme, methods is called insurance fraud - a felony in most states. This is one of the primary reasons why medical insurance rates are so high. It also makes getting approval for orthognathic surgery (for those of us with skeletal deformities who actually need this done) so hard in the first place.

You need to go to your primary care physician for a referral to an oral maxillofacial surgeon in your medical group first, and tell them what problems this is causing you, other than its appearance. This way, your physician and the OMS can determine whether or not you have a skeletal deformity as many medical insurance plans will not take a referral from an orthodontist or dentist. I've found that it's best to have a cephalometric x-ray in hand when you go.

There are times when a severe overjet (overbite) and open bite can be corrected with braces alone because it's merely a problem with the alignment of the teeth. A co-worker of mine has a severe open bite that makes it impossible for her to incise her food with her front teeth; but, for her, it's just that her teeth are out of alignment. She qualified as a candidate for Invisilign and is going through that program now.

Most orthodontists are willing to work out an affordable payment plan with patients, and your dental insurance will cover part of the cost.

[bmjcllc]

I am 30 years old and have severe skeletal deformation due to tongue thrusting. It has caused me to have a huge open bite. My braces were put on in September 2010 and I am meeting with a jaw surgeon next month. Since my case is extreme, I am expecting that I won't have trouble getting it covered by my insurance since it is more than just cosmetic. I'll re-post after I meet with the surgeon next month.

Brian

[mikeg]

If you aren't experiencing TMJ disorder symptoms now, than there is a good chance that you will... This is a good case for your insurance.

[smile_sos]

If you aren't experiencing TMJ disorder symptoms now, than there is a good chance that you will... This is a good case for your insurance.

First of all, this forum is awesome. It's so helpful to see what everyone else is going through. Smylex totally inspired me.

Secondly, in response to bmjcllc, I'm 33 and I've seen two orthos in the last week and have been told that I also need jaw surgery to fully correct my teeth and that I would greatly benefit aesthetically from the procedure. I had braces before and the ortho then advised to have the jaw surgery but my parents refused. That was like 20 years ago...I live in CA and have Blue Shield. Please let us know how it goes!

My first ortho completely eliminated the possibility that insurance would cover it and acted like I've waited my whole life to spend $35K+ on orthodontia (he gave me a range between purchasing a new Toyota Prius and a new BMW 7 series - pretty wide and terrifying range). AND he made me feel like I should have been living in a circus tent all this time.

In response to mikeg: My latest orthodontist (this morning) said not to even mention TMJ because it won't be covered, but encouraged me to try with other ailments. I have Blue Shield, though, so all insurance policies are different. Kaiser is much better for that stuff is what I was told today.

If you have pain/difficulty chewing or get headaches, have a history of sinus problems/lots of colds, that could help. I realized today that a lot of these problems are an effect of skeletal deformity (I have a larger upper jaw - forget what that's called) and I also have burping issues that I saw someone else mention here. So it's possible to get it covered, but not guaranteed based on all the info I've been gathering.

I'm going to see another orthodontist to round out the diagnoses a bit, and the consultations are free (my latest one was, anyway), even though I know orthodontists are not an accepted source of referral. I'm also going to see what an ENT will say about jaw surgery in relation to breathing and burping. I'll do what I can to make this happen! If I'm going to be paying for a new car, I'd rather have the car.