My experience with trying to get jaw surgery via insurance

[ReccesedSlavic]

So I would like to begin with saying this was a total nightmare it was horrible from the beginning i was met with numerous doctors telling me surgery was drastic even thought my recession is clear, so I complained tmj and I was sent to a tmj professional during the appointment he did something useful he told me the amount of recession i had but I don’t even think it was accurate he made molds of my jaw in different positions to see if I had tmj and then sent me for ct scans i ended up going and paying 600 dollars out of pocket for him to send me an email saying this

And then he ghosted me, here’s what I can take away from this don’t waste your time trying to get insurance covered surgery it will be a big waste of time

 

[yussimania]

So I would like to begin with saying this was a total nightmare it was horrible from the beginning i was met with numerous doctors telling me surgery was drastic even thought my recession is clear, so I complained tmj and I was sent to a tmj professional during the appointment he did something useful he told me the amount of recession i had but I don’t even think it was accurate he made molds of my jaw in different positions to see if I had tmj and then sent me for ct scans i ended up going and paying 600 dollars out of pocket for him to send me an email saying thisView attachment 5254341
And then he ghosted me, here’s what I can take away from this don’t waste your time trying to get insurance covered surgery it will be a big waste of time

Well at least you have a CT scan of your skull

 

[ReccesedSlavic]

Well at least you have a CT scan of your skull

I was thinking that earlier I’ll take advantage of it later not all a loss

 

[Firstname.Lastname]

So I would like to begin with saying this was a total nightmare it was horrible from the beginning i was met with numerous doctors telling me surgery was drastic even thought my recession is clear, so I complained tmj and I was sent to a tmj professional during the appointment he did something useful he told me the amount of recession i had but I don’t even think it was accurate he made molds of my jaw in different positions to see if I had tmj and then sent me for ct scans i ended up going and paying 600 dollars out of pocket for him to send me an email saying thisView attachment 5254341
And then he ghosted me, here’s what I can take away from this don’t waste your time trying to get insurance covered surgery it will be a big waste of time

Have you read your policy or done any investigation into what the standard is to meet insurance coverage for whichever jaw surgery you want/need is?

I'm saying this since I don't know how this diagnosis would be meaningful in terms of jaw surgery coverage. This is a generalized radiology report. It does not describe the amount of recession or if any is or isn't present. There is no discussion of airway. There is no discussion of function.

What qualifies as "normal" or or no abnormalities. I would even go so far as to write him back asking him, what qualifies as normal, what qualifies as an abnormality. How has he made that determination objectively? Especially in light of clear recession, and I would point it out the issue. Point out that he specifically told you in the appointment that you had X recession, but in essence now claims there is none in writing, since he is calling said recession "normal". When it is not normal to have recession.

Do it all in writing so you can have documentation. Generally the larger pile of papers you have the stronger the case. What those papers say generally matters less so. Since normal people tend to just say fuck it I aint reading that, it looks strong case. Then call it a day.

I was thinking that earlier I’ll take advantage of it later not all a loss

I'd take it to another specalist and ask them to review it. If they think theirs a problem with your jaw to write a description of it, as well as possible functional issue for documentation and what's needed to correct the issue.

 

[TrueScandinavian]

Going through the same shit right now. Its a fucking nightmare

 

[ReccesedSlavic]

Have you read your policy or done any investigation into what the standard is to meet insurance coverage for whichever jaw surgery you want/need is?

I'm saying this since I don't know how this diagnosis would be meaningful in terms of jaw surgery coverage. This is a generalized radiology report. It does not describe the amount of recession or if any is or isn't present. There is no discussion of airway. There is no discussion of function.

What qualifies as "normal" or or no abnormalities. I would even go so far as to write him back asking him, what qualifies as normal, what qualifies as an abnormality. How has he made that determination objectively? Especially in light of clear recession, and I would point it out the issue. Point out that he specifically told you in the appointment that you had X recession, but in essence now claims there is none in writing, since he is calling said recession "normal". When it is not normal to have recession.

Do it all in writing so you can have documentation. Generally the larger pile of papers you have the stronger the case. What those papers say generally matters less so. Since normal people tend to just say fuck it I aint reading that, it looks strong case. Then call it a day.


I'd take it to another specalist and ask them to review it. If they think theirs a problem with your jaw to write a description of it, as well as possible functional issue for documentation and what's needed to correct the issue.

I am under kaiser they cover it, I have a 6mm overbite class 2 it should be covered but they are being reluctant about it

 

[Firstname.Lastname]

I am under kaiser they cover it, I have a 6mm overbite class 2 it should be covered but they are being reluctant about it

Just keep gathering documentation, and pushing back then. Remind them that under the policy you qualify. Yet the medical doctors are obstructing you from getting a medically necessary procedure, without providing a genuine reason why. Instead doing things like writing documentation with false statements calming you are normative, despite their own policy specifically outlining the coverage. Thus making their own actions completely inconsistent with their own medical policies. Which is why they are systematically gaslighting you with false statements instead of documenting the actual medical condition you have.

This is all about making them explain and justify anything that is against your narrative and their own documentation. If the deficit actually exist, then they are going to give in quickly to that kind of pushback. IE admit in writing documentation the problem. Which then nessicates the coverage. They cannot continue to gaslight base on falsehoods are they are sticking their own personal ass's out legally for nothing.