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Re: [Orthognathic Surgery Support ] Re: My Story - Approved!

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  • sandy crittenden
    How did both of you get it approved?  Was there a medical reason? My daughter has had her surgery denied for the last 6 months by healthplus.  We are at
    Message 1 of 18 , Nov 1, 2008
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      How did both of you get it approved?  Was there a medical reason? My daughter has had her surgery denied for the last 6 months by healthplus.  We are at re-enrollment time and not sure what insurance company to choose.  They are denying it because they say there is not a medical reason. 

      --- On Fri, 10/31/08, amybrianphoto <amybrianphoto@...> wrote:

      From: amybrianphoto <amybrianphoto@...>
      Subject: [Orthognathic Surgery Support ] Re: My Story - Approved!
      To: orthognathicsurgerysupport@yahoogroups.com
      Date: Friday, October 31, 2008, 6:44 PM






      Congratulations! I know the feeling. I was approved by Cigna a few
      weeks ago after everyone in the OS office kept telling me Cigna never
      approves this surgery. I was so in shock! I didn't even have to try
      that hard, I got a denial at first, the OD sent her molds and tada!
      it was approved. I was all ready for a fight. I still expect a letter
      or a phone call telling me they made a mistake and it's not approved.
      I even put the approval letter on my fridge. I don't think i'll
      actually believe it until the day of my surgery.
      Retainer, isn't that the appliance you wear after the braces are off
      to keep the teeth from shifting back. I don't know how that relates
      to the OS though cause that's usually the OD's thing.

      --- In orthognathicsurgery support@yahoogro ups.com, "rxblitzrx"
      <rxblitzrx@. ..> wrote:
      >
      > I just got off the phone with my OMS and they told me MY SURGERY IS
      > !!!!!!!!!!!! !!!!!!!!! !!!!!!!!! !!!!!!!
      > APPROVED BY AETNA
      > !!!!!!!!!!!! !!!!!!!!! !!!!!!!!! !!!!!!!
      >
      >
      > I wanted to start a new thread to document my case and share all my
      > information for future surgery candidates. I can't think right now
      > because I'm still in shock from the good news, so I'll write more
      > later. I just had to spill this somewhere!!
      >
      >
      > I do have one question though:
      >
      > 1. My surgery has been approved for everything EXCEPT a retainer.
      > What's a retainer?
      >


















      [Non-text portions of this message have been removed]
    • Lynnda Vincent
      What state do you live in??  If you Live in California.. Kaiser Permanente is great on this.. They have their own department for this and is covered by them..
      Message 2 of 18 , Nov 1, 2008
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        What state do you live in??  If you Live in California.. Kaiser Permanente is great on this.. They have their own department for this and is covered by them..
         
        Hugs!
         
        Lynnda

        --- On Sat, 11/1/08, sandy crittenden <scrittenden8@...> wrote:

        From: sandy crittenden <scrittenden8@...>
        Subject: Re: [Orthognathic Surgery Support ] Re: My Story - Approved!
        To: orthognathicsurgerysupport@yahoogroups.com
        Date: Saturday, November 1, 2008, 5:04 AM






        How did both of you get it approved?  Was there a medical reason? My daughter has had her surgery denied for the last 6 months by healthplus.  We are at re-enrollment time and not sure what insurance company to choose.  They are denying it because they say there is not a medical reason. 

        --- On Fri, 10/31/08, amybrianphoto <amybrianphoto@ yahoo.com> wrote:

        From: amybrianphoto <amybrianphoto@ yahoo.com>
        Subject: [Orthognathic Surgery Support ] Re: My Story - Approved!
        To: orthognathicsurgery support@yahoogro ups.com
        Date: Friday, October 31, 2008, 6:44 PM

        Congratulations! I know the feeling. I was approved by Cigna a few
        weeks ago after everyone in the OS office kept telling me Cigna never
        approves this surgery. I was so in shock! I didn't even have to try
        that hard, I got a denial at first, the OD sent her molds and tada!
        it was approved. I was all ready for a fight. I still expect a letter
        or a phone call telling me they made a mistake and it's not approved.
        I even put the approval letter on my fridge. I don't think i'll
        actually believe it until the day of my surgery.
        Retainer, isn't that the appliance you wear after the braces are off
        to keep the teeth from shifting back. I don't know how that relates
        to the OS though cause that's usually the OD's thing.

        --- In orthognathicsurgery support@yahoogro ups.com, "rxblitzrx"
        <rxblitzrx@. ..> wrote:
        >
        > I just got off the phone with my OMS and they told me MY SURGERY IS
        > !!!!!!!!!!!! !!!!!!!!! !!!!!!!!! !!!!!!!
        > APPROVED BY AETNA
        > !!!!!!!!!!!! !!!!!!!!! !!!!!!!!! !!!!!!!
        >
        >
        > I wanted to start a new thread to document my case and share all my
        > information for future surgery candidates. I can't think right now
        > because I'm still in shock from the good news, so I'll write more
        > later. I just had to spill this somewhere!!
        >
        >
        > I do have one question though:
        >
        > 1. My surgery has been approved for everything EXCEPT a retainer.
        > What's a retainer?
        >

        [Non-text portions of this message have been removed]


















        [Non-text portions of this message have been removed]
      • rxblitzrx
        ... daughter has had her surgery denied for the last 6 months by healthplus.  We are at re-enrollment time and not sure what insurance company to choose. 
        Message 3 of 18 , Nov 1, 2008
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          --- In orthognathicsurgerysupport@yahoogroups.com, sandy crittenden
          <scrittenden8@...> wrote:
          >
          > How did both of you get it approved?  Was there a medical reason? My
          daughter has had her surgery denied for the last 6 months by
          healthplus.  We are at re-enrollment time and not sure what insurance
          company to choose.  They are denying it because they say there is not
          a medical reason. 
          >

          I have a copy of the letter my OMS sent to the insurance company. It
          states that this is a medically necessary procedure to correct a
          dysfunctional relationship between the upper and lower jaw. This is
          not a cosmetic reason. I've had several people tell me that my OMS is
          known for two things... doing the most of this surgery on the block,
          and getting it approved.
        • rxblitzrx
          ... Permanente is great on this.. They have their own department for this and is covered by them.. ... I live in Texas! Aetna has their own Oral Surgery
          Message 4 of 18 , Nov 1, 2008
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            --- In orthognathicsurgerysupport@yahoogroups.com, Lynnda Vincent
            <luckibear7@...> wrote:
            >
            > What state do you live in??  If you Live in California.. Kaiser
            Permanente is great on this.. They have their own department for this
            and is covered by them..
            >  
            > Hugs!
            >  
            > Lynnda
            >

            I live in Texas! Aetna has their own Oral Surgery department too. That
            was actually one of the specific things the insurance lady in my OMS
            office mentioned when she "suggested" I get Aetna.
          • Lynnda Vincent
            Well that is great!!  I hope you get approved with no hassles.. :)   ... From: rxblitzrx Subject: [Orthognathic Surgery Support ] Re:
            Message 5 of 18 , Nov 1, 2008
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              Well that is great!!  I hope you get approved with no hassles.. :)
               


              --- On Sat, 11/1/08, rxblitzrx <rxblitzrx@...> wrote:

              From: rxblitzrx <rxblitzrx@...>
              Subject: [Orthognathic Surgery Support ] Re: My Story - Approved!
              To: orthognathicsurgerysupport@yahoogroups.com
              Date: Saturday, November 1, 2008, 9:30 PM






              --- In orthognathicsurgery support@yahoogro ups.com, Lynnda Vincent
              <luckibear7@ ...> wrote:
              >
              > What state do you live in??  If you Live in California.. Kaiser
              Permanente is great on this.. They have their own department for this
              and is covered by them..
              >  
              > Hugs!
              >  
              > Lynnda
              >

              I live in Texas! Aetna has their own Oral Surgery department too. That
              was actually one of the specific things the insurance lady in my OMS
              office mentioned when she "suggested" I get Aetna.


















              [Non-text portions of this message have been removed]
            • sandy crittenden
              We are in MI.  Is there any way I can get a copy of that letter your OS sent to the Ins. CO. ... From: rxblitzrx Subject: [Orthognathic
              Message 6 of 18 , Nov 2, 2008
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                We are in MI.  Is there any way I can get a copy of that letter your OS sent to the Ins. CO.

                --- On Sun, 11/2/08, rxblitzrx <rxblitzrx@...> wrote:
                From: rxblitzrx <rxblitzrx@...>
                Subject: [Orthognathic Surgery Support ] Re: My Story - Approved!
                To: orthognathicsurgerysupport@yahoogroups.com
                Date: Sunday, November 2, 2008, 12:30 AM











                --- In orthognathicsurgery support@yahoogro ups.com, Lynnda Vincent

                <luckibear7@ ...> wrote:

                >

                > What state do you live in??  If you Live in California.. Kaiser

                Permanente is great on this.. They have their own department for this

                and is covered by them..

                >  

                > Hugs!

                >  

                > Lynnda

                >



                I live in Texas! Aetna has their own Oral Surgery department too. That

                was actually one of the specific things the insurance lady in my OMS

                office mentioned when she "suggested" I get Aetna.





























                [Non-text portions of this message have been removed]
              • jbrockert@wowway.com
                Sandy-I live in Michigan and I have Blue Cross/Blue Shield and they gave me no hassle with anything.  I never heard a peep from them.  My surgeon s office
                Message 7 of 18 , Nov 3, 2008
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                  Sandy-I live in Michigan and I have Blue Cross/Blue Shield and they gave me no hassle with anything.  I never heard a peep from them.  My surgeon's office handled everything.  The only thing I had to pay for was my chin work.

                  Jeremy

                  On Sun, 2 Nov 2008 15:02:39 -0800 (PST), sandy crittenden wrote
                  > We are in MI.  Is there any way I can get a copy of that letter your OS sent to the Ins. CO.
                  >
                  > --- On Sun, 11/2/08, rxblitzrx <rxblitzrx@...> wrote:
                  > From: rxblitzrx <rxblitzrx@...>
                  > Subject: [Orthognathic Surgery Support ] Re: My Story - Approved!
                  > To: orthognathicsurgerysupport@yahoogroups.com
                  > Date: Sunday, November 2, 2008, 12:30 AM
                  >
                  > --- In orthognathicsurgery support@yahoogro ups.com, Lynnda Vincent
                  >
                  > <luckibear7@ ...> wrote:
                  >
                  > >
                  >
                  > > What state do you live in??  If you Live in California.. Kaiser
                  >
                  > Permanente is great on this.. They have their own department for this
                  >
                  > and is covered by them..
                  >
                  > >  
                  >
                  > > Hugs!
                  >
                  > >  
                  >
                  > > Lynnda
                  >
                  > >
                  >
                  > I live in Texas! Aetna has their own Oral Surgery department too. That
                  >
                  > was actually one of the specific things the insurance lady in my OMS
                  >
                  > office mentioned when she "suggested" I get Aetna.
                  >
                  > [Non-text portions of this message have been removed]
                  >
                  >

                  Jeremy
                  --
                  WOW! Homepage (http://www.wowway.com)

                  Midwest Nest Coalition Homepage (http://www.midwestnestcoalition.org)



                  [Non-text portions of this message have been removed]
                • swissmiss_86
                  Hi Jeremy, I live in MI w/ BCBS, too, and I was told that BCBS didn t do pre- authorization so I just have to have the surgery and hope they pay for it
                  Message 8 of 18 , Nov 6, 2008
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                    Hi Jeremy,

                    I live in MI w/ BCBS, too, and I was told that BCBS didn't do pre-
                    authorization so I just have to have the surgery and hope they pay
                    for it afterward. Is this how it worked for you? Also, can I ask
                    what sort of plan you have with Blue Cross (ppo, traditional, etc)?

                    Thanks,
                    Anne


                    --- In orthognathicsurgerysupport@yahoogroups.com, jbrockert@...
                    wrote:
                    >
                    > Sandy-I live in Michigan and I have Blue Cross/Blue Shield and they
                    gave me no hassle with anything.  I never heard a peep from them.  My
                    surgeon's office handled everything.  The only thing I had to pay for
                    was my chin work.
                    >
                    > Jeremy
                    >
                    > On Sun, 2 Nov 2008 15:02:39 -0800 (PST), sandy crittenden wrote
                    > > We are in MI.  Is there any way I can get a copy of that letter
                    your OS sent to the Ins. CO.
                    > >
                    > > --- On Sun, 11/2/08, rxblitzrx <rxblitzrx@...> wrote:
                    > > From: rxblitzrx <rxblitzrx@...>
                    > > Subject: [Orthognathic Surgery Support ] Re: My Story - Approved!
                    > > To: orthognathicsurgerysupport@yahoogroups.com
                    > > Date: Sunday, November 2, 2008, 12:30 AM
                    > >
                    > > --- In orthognathicsurgery support@yahoogro ups.com, Lynnda
                    Vincent
                    > >
                    > > <luckibear7@ ...> wrote:
                    > >
                    > > >
                    > >
                    > > > What state do you live in??  If you Live in California.. Kaiser
                    > >
                    > > Permanente is great on this.. They have their own department for
                    this
                    > >
                    > > and is covered by them..
                    > >
                    > > >  
                    > >
                    > > > Hugs!
                    > >
                    > > >  
                    > >
                    > > > Lynnda
                    > >
                    > > >
                    > >
                    > > I live in Texas! Aetna has their own Oral Surgery department too.
                    That
                    > >
                    > > was actually one of the specific things the insurance lady in my
                    OMS
                    > >
                    > > office mentioned when she "suggested" I get Aetna.
                    > >
                    > > [Non-text portions of this message have been removed]
                    > >
                    > >
                    >
                    > Jeremy
                    > --
                    > WOW! Homepage (http://www.wowway.com)
                    >
                    > Midwest Nest Coalition Homepage
                    (http://www.midwestnestcoalition.org)
                    >
                    >
                    >
                    > [Non-text portions of this message have been removed]
                    >
                  • rxblitzrx
                    November 6, 2008 Update: A retainer is used in the upper palette if your maxilla is cut into more than one piece. Most likely my surgery won t be this severe
                    Message 9 of 18 , Nov 6, 2008
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                      November 6, 2008 Update:

                      A retainer is used in the upper palette if your maxilla is cut into
                      more than one piece. Most likely my surgery won't be this severe so I
                      won't need this equipment.

                      Other than that, everything has been completely covered by my
                      insurance plan. They only covered one day in the hospital though.

                      Next steps: wait for orthodontist to clear me, and get cleared by my
                      oral surgeon. The office manager will then call me to schedule a
                      surgery date.
                    • rxblitzrx
                      Just got back from my OMD appointment. They took measurements of my face (distance from teeth to eyes, distance across, distance from lip to nose, etc...) and
                      Message 10 of 18 , Nov 20, 2008
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                        Just got back from my OMD appointment. They took measurements of my
                        face (distance from teeth to eyes, distance across, distance from lip
                        to nose, etc...) and it was awesome!

                        My next appointment will be to see possible before and after photos,
                        and to talk about care. I have prescriptions for Flonase (nose),
                        Peridex (mouthwash), Decadron (anti-inflammatory steroid), and Valtrex
                        (cold sore prophylaxis).

                        Can't wait to get started on these. =)

                        The only sucky part is that they don't like giving anti-anxiety meds
                        because the general anesthesia doesn't react well with it. Most
                        likely a synergistic reaction that can lead to severe respiratory
                        depression.


                        More updates later.
                      • slapnutsgt
                        Hmm, well I take paxil anyway and was taking that up to surgery, plus when i was in pre-op, the anestesiologist gave me some bravery drugs although she never
                        Message 11 of 18 , Nov 20, 2008
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                          Hmm, well I take paxil anyway and was taking that up to surgery, plus
                          when i was in pre-op, the anestesiologist gave me some "bravery
                          drugs" although she never actually told me what it was.

                          --- In orthognathicsurgerysupport@yahoogroups.com, "rxblitzrx"
                          <rxblitzrx@...> wrote:
                          >
                          > Just got back from my OMD appointment. They took measurements of my
                          > face (distance from teeth to eyes, distance across, distance from
                          lip
                          > to nose, etc...) and it was awesome!
                          >
                          > My next appointment will be to see possible before and after photos,
                          > and to talk about care. I have prescriptions for Flonase (nose),
                          > Peridex (mouthwash), Decadron (anti-inflammatory steroid), and
                          Valtrex
                          > (cold sore prophylaxis).
                          >
                          > Can't wait to get started on these. =)
                          >
                          > The only sucky part is that they don't like giving anti-anxiety meds
                          > because the general anesthesia doesn't react well with it. Most
                          > likely a synergistic reaction that can lead to severe respiratory
                          > depression.
                          >
                          >
                          > More updates later.
                          >
                        • Dominique Nabholz
                          Before my last oral surgery I took a Valium an hour before the procedure. It was under conscious sedation, though. ... From:
                          Message 12 of 18 , Nov 20, 2008
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                            Before my last oral surgery I took a Valium an hour before the procedure.
                            It was under conscious sedation, though.

                            -----Original Message-----
                            From: orthognathicsurgerysupport@yahoogroups.com
                            [mailto:orthognathicsurgerysupport@yahoogroups.com] On Behalf Of slapnutsgt
                            Sent: Thursday, November 20, 2008 7:13 PM
                            To: orthognathicsurgerysupport@yahoogroups.com
                            Subject: [Orthognathic Surgery Support ] Re: My Story - Approved!

                            Hmm, well I take paxil anyway and was taking that up to surgery, plus when i
                            was in pre-op, the anestesiologist gave me some "bravery drugs" although she
                            never actually told me what it was.

                            --- In orthognathicsurgerysupport@yahoogroups.com, "rxblitzrx"
                            <rxblitzrx@...> wrote:
                            >
                            > Just got back from my OMD appointment. They took measurements of my
                            > face (distance from teeth to eyes, distance across, distance from
                            lip
                            > to nose, etc...) and it was awesome!
                            >
                            > My next appointment will be to see possible before and after photos,
                            > and to talk about care. I have prescriptions for Flonase (nose),
                            > Peridex (mouthwash), Decadron (anti-inflammatory steroid), and
                            Valtrex
                            > (cold sore prophylaxis).
                            >
                            > Can't wait to get started on these. =)
                            >
                            > The only sucky part is that they don't like giving anti-anxiety meds
                            > because the general anesthesia doesn't react well with it. Most likely
                            > a synergistic reaction that can lead to severe respiratory depression.
                            >
                            >
                            > More updates later.
                            >



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                          • rxblitzrx
                            Today is December 3rd. After looking at all the molds and xrays, my surgeon has decided to go with an Upper Jaw surgery only. I m really happy that my surgery
                            Message 13 of 18 , Dec 3, 2008
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                              Today is December 3rd.

                              After looking at all the molds and xrays, my surgeon has decided to go
                              with an Upper Jaw surgery only.

                              I'm really happy that my surgery is less complicated now and hopefully
                              still get the same outcome that we're trying to achieve.
                            • margaret wilson
                              Hi, I also am having upper surgery only.  Might I ask why your surgeon thought that only upper was necessary? Margaret ... From: rxblitzrx
                              Message 14 of 18 , Dec 3, 2008
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                                Hi,

                                I also am having upper surgery only.  Might I ask why your surgeon thought that only upper was necessary?

                                Margaret

                                --- On Wed, 12/3/08, rxblitzrx <rxblitzrx@...> wrote:
                                From: rxblitzrx <rxblitzrx@...>
                                Subject: [Orthognathic Surgery Support ] Re: My Story - Approved!
                                To: orthognathicsurgerysupport@yahoogroups.com
                                Date: Wednesday, December 3, 2008, 2:11 PM











                                Today is December 3rd.



                                After looking at all the molds and xrays, my surgeon has decided to go

                                with an Upper Jaw surgery only.



                                I'm really happy that my surgery is less complicated now and hopefully

                                still get the same outcome that we're trying to achieve.





























                                [Non-text portions of this message have been removed]
                              • rxblitzrx
                                ... thought that only upper was necessary? ... Once he looked at the computer generated models of my skeleton and looking me over again in person, he decided
                                Message 15 of 18 , Dec 3, 2008
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                                  --- In orthognathicsurgerysupport@yahoogroups.com, margaret wilson
                                  <kjpmemw@...> wrote:
                                  >
                                  > Hi,
                                  >
                                  > I also am having upper surgery only.  Might I ask why your surgeon
                                  thought that only upper was necessary?
                                  >
                                  > Margaret
                                  >
                                  >
                                  >

                                  Once he looked at the computer generated models of my skeleton and
                                  looking me over again in person, he decided that my lower jaw was in
                                  proper proportions to the rest of my face. I have what looks like an
                                  underbite, but my chin actually lines up well with my forehead.
                                  There's a lot of other technical stuff but basically, my upper jaw
                                  just needs to come out and drop down some.

                                  I was scared that this would make my face look too full... maybe like
                                  a gorilla, since my entire life I've felt that my lower jaw was too
                                  far forward. However, he assured me that I would look normal and
                                  everything would be in the right proportions.

                                  One thing I've learned in all my studies of orthodontics and
                                  orthognathic surgery is that I don't know crap. But I've learned to
                                  trust the doctors and just follow their recommendation. They've done
                                  this for years and years and they know what's best. My doctor even
                                  considers your ethnic background and what's considered "normal" for an
                                  asian male (in my case). We have flatter faces, but he's already
                                  taken that into account. So even with a more drastic upper
                                  advancement and no lower regression, I won't look too full in the mouth.

                                  I can't wait!
                                • rxblitzrx
                                  I just got a letter from Aetna talking about pre-existing conditions and previous insurance coverage. The letter says: We received a medical claim. Your
                                  Message 16 of 18 , Dec 6, 2008
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                                    I just got a letter from Aetna talking about pre-existing conditions
                                    and previous insurance coverage. The letter says:

                                    "We received a medical claim. Your medical plan contains a
                                    pre-existing condition limitation. Therefore, we need to determine if
                                    any medical conditions are considered pre-existing under this plan."

                                    etc...etc...
                                  Your message has been successfully submitted and would be delivered to recipients shortly.