Orthogonathic surgery: How do I get my Health insurance to pay for it?

My orthodontist and dentist feel that I need to get Othorgonathic surgery to fix my underbite. They want me to to get surgery to my upper and lower jaws. To be honest I agree with them. I cant close my mouth comfortably along with the fact that I grind my teeth at night and I am already developing minor TMJ issues. However it says this in the exlusions & limitations section of my benefits information
Upper and Lower jaw bone surgery except as required for the direct treatment of accute traumatic injury or cancer Orthogonathic surgery, jaw alignment and treatment for the tempromandibular joint except atreatment of obstructive sleep apnea
Services for the evaluation and treatment of tempromandibular joint syndrome (TMJ) whether the services are considered to be medical or dental in nature.
Has anyone else run into this problem? Were you able to successfully appeal? if so how? By the way I'm over 19.

Thanks I would like to be able to smile in pics. for a change!

Traveling outside the country is not an option for me. For the surgery. Travel outside the US is ver cost prohibitive for me.

Call a very experienced oral maxillofacial surgeon. They are usually located in educational medical schools or consult a trauma hospitals....the folks that operate on gun shot wounds to the face....that is the surgeon you want doing this type of surgery....it is complicated. Call this type of surgeons private practice and ask who is in charge of billing...they usually know how different insurance cos work and how to go about getting coverage. I'd also make sure the doctor is not only a DDS (doctor of denistry), but also an MD (medical doc). Most really qualified oral maxillofacial doctors are...these guys are like artists or even more qualified than plastic surgeons.

Knee joint replacement surgery has become very common nowadays. My cousin also got her hip replacement surgery in India through the forerunners healthcare .She is more than very happy with the results. She is totally pain free now. She just paid 25% of the amount she was quoted in USA and is all praise for this forerunners healthcare company.


Forerunners Healthcare is very famous in India. I read a lot about them in the Newspapers and magazines. I have read a lot of their patient stories also. They arrange financing for USA, Canadian, UK and other international patients who plan to have surgery abroad for low price, as all joint surgery is not covered by insurance in USA or by NHS in the UK. They also have photos pasted of their International patients. You can checkout their website. There are huge cost savings. As a doctor I personally believe that your surgery can be easily handled in India, as the quality of healthcare available In India is simply best in the world. The surgeons are USA/UK trained and facilities are 5 star.

Many patients travel from United States of America and UK to get low cost surgery in India. Indian corporate hospitals are comparable to hospitals anywhere in the world. In fact, India has medical facilities that are comparable with the USA, UK and Canada. India offers World Class Medical Facilities, comparable with any of the western countries. India has state of the art Hospitals and the best medical experts. With the best infrastructure, the best possible Medical facilities, accompanied with the most competitive prices, you can get the treatment done in India at the lowest prices.


http://www.forerunnershealthcare.com
Hope this helps.

my only advice is to keep appealing to your insurance company...

I've a similar problem myself... not only do I have an overbite because of mandibular hypoplasia but also have whats called a deep bite. I have moderate tmj symptoms and have a very narrow jaw.

My insurance has exclusions for any oral surgery not done for traumatic injury. I've even gone through a sleep study to try the apnea route (which your insurance by the exclusions you mentioned would pay if it would correct sleep apnea) mine insurance still denies coverage for.

I've been appealing just about every year since i was 18 I'm now 29... and don't have the 32k for the first surgery 20k for the second surgery and 10k for the braces and orthodontia that would follow the oral surgeries.

Good Luck!

The oral surgery being very expensive and on top of it the lack of insurance coverage for many is the reason that India has become foremost destination. Paying out of pocket 1/5 of US cost is very attractive hope the quality dentistry offered there. Try your google search for affordable oral surgery treatment in india, and no harm in exploring the available options for your new smile.