Help!! regarding insurance approval!!!!!!!!!!!!

[FreshPrince]

So i finally see the ENT doctor in which i waited 6 months to see thinking he would be the one declining or approving my request for surgery. And all he ends up doing as handing me a sheet with the following information.

Quote:
1. Letter from requesting oral surgeon or DDS
2. Pertinent medical history relating to the surgety request
3. Reports of diagnostic testing and examinations
4. Results of clinical examination, and how it relates to the proposed surgery.
5. Conservative treatment modalities that have been attempted with the outcomes over minimum of 2 years.
6. Panoramic and Cephalometric tracing completed within the last 3 months, showing the preoperative position and projected post-op position of the facial bones with measurements and method of analysis included.
7.Recent study models of the teeth, including index bite to properly articulate the models in the pre-treatment position.
8. Facial and occlusion photographs within last 3 months

Which is pretty much a requirement list that i am supposed to give to my orthodontist to complete to build me a case to be submitted to my medical group for approval.
ENT doctor said he was going to do his part on this side whatever that means and how surgery's are expensive and insurance want any reason to deny them. But thinks he can get me approved.


So s this not a lot of info to ask from my ortho? I mean he did request to try and get surgery but all he has done is put on my braces. does he even have the knowledge to help me with this?
I have already seen multiple doctors and a physical therapist and they all basically my bite was terrible and only surgery could help me.

So what should i do? Just hand the paper to the ortho?gather some info beforehand?Have a oral surgeon do it? anything helps?
I want my report to be bullet proof so it decreases my chances of getting declined.

I am in California and my medical group is sharp stealey and insurance is Health net if that helps

Any piece of info helps.

[smylex]

Have you been to your primary care physician about this? They can direct the medical group to authorize a referral for you to have a consultation with the oral maxillofacial surgeon which will be a first step in keeping the insurance company from denying your claim. This is not a guarantee of your claim being approved.

Your orthodontist can give their opinion on whether or not they think that getting braces will correct your malocclusion or if surgery is necessary. If you need orthognathic surgery, the medical insurance is not going to take the word of a dentist or orthodontist as this is a medical problem (skeletal deformity).

And, no report is bullet proof, but you can appeal a denial to an authorization for surgery.