Re: insurance advice needed

[Guest guest]

Hello,

I had to fight with my insurance for a year before they covered the surgery.

They kept denying my surgery because they thought it was only cosmetic. I have

been told that the insurance companies usually always denying a claim the first

time around.

Tonia

[Guest guest]

Wow Tonia - what a battle you must have had! I am hoping for the

best - I am about to make a bunch of phone calls and send out some

letters. Do you have the same insurance as I do?

> Hello,

>

> I had to fight with my insurance for a year before they covered

the surgery. They kept denying my surgery because they thought it

was only cosmetic. I have been told that the insurance companies

usually always denying a claim the first time around.

>

> Tonia

[Guest guest]

I have CBSA, its with my Job at the County. They really could have denied my

claim and I really couldn't have done that much about it. Since they are self

insured they don't fall under the states regulations for Insurance Companies. I

shared my story, because I really feel if you are persistent that the insurance

companies will eventually give in if they realize that you aren't going to give

in.

Good luck and keep with it, I had the surgery March 27th and on Wednesday I

finally get my wires off. I am still not sure if the surgery is worth all the

e-mails and fighting that I had to do. When I woke up from surgery I was like I

can't believe I fought so hard for this surgery. What did I get myself into...

I have been told and I believe it more and more each day that eventually it will

all be worth it. Just waiting for that day...lol

Well keep us posted.

Tonia

[Guest guest]

Thank you for your words of advice. I will keep fighting this

battle - I am determined. My insurance company said that this is a

dental procedure and that my company opted out of providing coverage

under all circumstances for orthognathic surgery (no matter if it is

medically necessary or not) and they (my company) has to make a

special exception. I am now fighting with my company telling them

that this is not dental, but rather medical and they have to make

the exception - they are saying that they don't make exceptions. I

guess my next move it to start appealing the insurance company to

make them see this as medical procedure and then I don't know what

else to do. Wow, what a process. Can't believe you went through

this for a whole year.

Congrats on getting your wires off tomorrow!

> I have CBSA, its with my Job at the County. They really could

have denied my claim and I really couldn't have done that much about

it. Since they are self insured they don't fall under the states

regulations for Insurance Companies. I shared my story, because I

really feel if you are persistent that the insurance companies will

eventually give in if they realize that you aren't going to give

in.

>

> Good luck and keep with it, I had the surgery March 27th and on

Wednesday I finally get my wires off. I am still not sure if the

surgery is worth all the e-mails and fighting that I had to do.

When I woke up from surgery I was like I can't believe I fought so

hard for this surgery. What did I get myself into... I have been

told and I believe it more and more each day that eventually it will

all be worth it. Just waiting for that day...lol

> Well keep us posted.

>

> Tonia

[Guest guest]

Thank you for your words of advice. I will keep fighting this

battle - I am determined. My insurance company said that this is a

dental procedure and that my company opted out of providing coverage

under all circumstances for orthognathic surgery (no matter if it is

medically necessary or not) and they (my company) has to make a

special exception. I am now fighting with my company telling them

that this is not dental, but rather medical and they have to make

the exception - they are saying that they don't make exceptions. I

guess my next move it to start appealing the insurance company to

make them see this as medical procedure and then I don't know what

else to do. Wow, what a process. Can't believe you went through

this for a whole year.

Congrats on getting your wires off tomorrow!

> I have CBSA, its with my Job at the County. They really could

have denied my claim and I really couldn't have done that much about

it. Since they are self insured they don't fall under the states

regulations for Insurance Companies. I shared my story, because I

really feel if you are persistent that the insurance companies will

eventually give in if they realize that you aren't going to give

in.

>

> Good luck and keep with it, I had the surgery March 27th and on

Wednesday I finally get my wires off. I am still not sure if the

surgery is worth all the e-mails and fighting that I had to do.

When I woke up from surgery I was like I can't believe I fought so

hard for this surgery. What did I get myself into... I have been

told and I believe it more and more each day that eventually it will

all be worth it. Just waiting for that day...lol

> Well keep us posted.

>

> Tonia

[Guest guest]

Thank you for your words of advice. I will keep fighting this

battle - I am determined. My insurance company said that this is a

dental procedure and that my company opted out of providing coverage

under all circumstances for orthognathic surgery (no matter if it is

medically necessary or not) and they (my company) has to make a

special exception. I am now fighting with my company telling them

that this is not dental, but rather medical and they have to make

the exception - they are saying that they don't make exceptions. I

guess my next move it to start appealing the insurance company to

make them see this as medical procedure and then I don't know what

else to do. Wow, what a process. Can't believe you went through

this for a whole year.

Congrats on getting your wires off tomorrow!

> I have CBSA, its with my Job at the County. They really could

have denied my claim and I really couldn't have done that much about

it. Since they are self insured they don't fall under the states

regulations for Insurance Companies. I shared my story, because I

really feel if you are persistent that the insurance companies will

eventually give in if they realize that you aren't going to give

in.

>

> Good luck and keep with it, I had the surgery March 27th and on

Wednesday I finally get my wires off. I am still not sure if the

surgery is worth all the e-mails and fighting that I had to do.

When I woke up from surgery I was like I can't believe I fought so

hard for this surgery. What did I get myself into... I have been

told and I believe it more and more each day that eventually it will

all be worth it. Just waiting for that day...lol

> Well keep us posted.

>

> Tonia

[Guest guest]

Hello ,

My insurance was also through my company CBSA just did the paper work for

them. I also had to talk to my HR department. I did a lot of it through

e-mail so I would have a record of what was said. They told me that they

don't make any exceptions and that they just will not cover that type of

surgery. I kept asking for a reason why the are denying me of a medical

necessity operation. They really couldn't give me one besides the fact that

this is a very costly surgery. So in the end I won, I think I just drove the

HR guy crazy by e-mailing him like once a week to find out the progress of

why they don't cover it. It was a long year and I really thought that I had

lost the battle. I couldn't sue them, because of the wonderful self insured

thing, I really thought that I would have to do this surgery on my own. Good

thing it finally paid off though and they covered it.

Well, good luck to you on your quest for the Insurance and HR Department.

Tonia

[Guest guest]

Thanks Tonya! I contacted the insurance company yesterday and they

said that if the surgeon and I can show that it is a medical

necessity that they would make an exception (nice to tell me in the

first place before I got my HR dept. involved and blamed it on the

company I work for) so, I have sent my appeal letter off (faxed and

mailed) and the surgeon sent his stuff off (big surprise) two days

ago. I am crossing my fingers now!

[Guest guest]

Thanks Tonya! I contacted the insurance company yesterday and they

said that if the surgeon and I can show that it is a medical

necessity that they would make an exception (nice to tell me in the

first place before I got my HR dept. involved and blamed it on the

company I work for) so, I have sent my appeal letter off (faxed and

mailed) and the surgeon sent his stuff off (big surprise) two days

ago. I am crossing my fingers now!

[Guest guest]

Thanks Tonya! I contacted the insurance company yesterday and they

said that if the surgeon and I can show that it is a medical

necessity that they would make an exception (nice to tell me in the

first place before I got my HR dept. involved and blamed it on the

company I work for) so, I have sent my appeal letter off (faxed and

mailed) and the surgeon sent his stuff off (big surprise) two days

ago. I am crossing my fingers now!

[Guest guest]

Count your blessings. I had to send an appeal, a formal written

complaint to my insurance commissioner, and eventually move to another

state to get my insurance. It's a long story. But hang in there and

appreciate your luck once your insurance covers this. Good luck with

everything.

Clay

[Guest guest]

Count your blessings. I had to send an appeal, a formal written

complaint to my insurance commissioner, and eventually move to another

state to get my insurance. It's a long story. But hang in there and

appreciate your luck once your insurance covers this. Good luck with

everything.

Clay

[Guest guest]

Count your blessings. I had to send an appeal, a formal written

complaint to my insurance commissioner, and eventually move to another

state to get my insurance. It's a long story. But hang in there and

appreciate your luck once your insurance covers this. Good luck with

everything.

Clay

[Guest guest]

,

Great job, hope all goes well and that the insurance pays for it.

Good Luck!

Tonia

[Guest guest]

,

Great job, hope all goes well and that the insurance pays for it.

Good Luck!

Tonia

[Guest guest]

Clay,

Thank you, but I am going to be sweating about this over the next

few weeks since I dont't have any idea whether they are going to

cover this or not (surgery is set for 5/21 - I have appealed their

original decision and now am waiting for a response). I am hoping

everything goes smoothly with the appeal and extra documentation -

if not, on to the next step (may be asking a few questions about

that later if I get another no)

[Guest guest]

Clay,

Thank you, but I am going to be sweating about this over the next

few weeks since I dont't have any idea whether they are going to

cover this or not (surgery is set for 5/21 - I have appealed their

original decision and now am waiting for a response). I am hoping

everything goes smoothly with the appeal and extra documentation -

if not, on to the next step (may be asking a few questions about

that later if I get another no)

[Guest guest]

Clay,

Thank you, but I am going to be sweating about this over the next

few weeks since I dont't have any idea whether they are going to

cover this or not (surgery is set for 5/21 - I have appealed their

original decision and now am waiting for a response). I am hoping

everything goes smoothly with the appeal and extra documentation -

if not, on to the next step (may be asking a few questions about

that later if I get another no)

[Guest guest]

Hi . I have United Healthcare too, and am currently fighting

with them over covering the surgery. I'm so frustrated I think I'm

going to explode. They tend to loose paperwork a lot and everytime

you call them, they give you a different answer about what is going

on. Half the people there don't know what's going on!

My case is so messed up I don't know how it will ever get straight.

I had two different predetermination cases sent in by my doctor.

(so they would not get confused). The first was for a trigger point

injection on a tendon on my face. The trigger point injection

paperwork sent in by my doctor must have mentioned the jaw

(orognathic) surgery, but the intent was clearly not to try to get a

pretermination on coverage of the jaw surgery yet, only the trigger

point. Then the second predetermination request was sent a few

weeks later for the jaw surgery. (had to send the second one in

twice, because they lost the first, of coarse). They paid for my

trigger point procedure which I've already had. But they've told my

me on the phone they are denying the jaw surgery. I never got a

letter saying that or anything explaining appeals. I called UHC to

get them to mail the supposed denial of jaw surgery again. They

sent the trigger point letter instead (which I had already gotten a

few months ago). I think they are confused and think that the 1st

thing request was for trigger point & jaw surgery, and that the 2nd

thing is an appeal for jaw surgery.

I'm making calls nearly every day to try to fix this. Tomorrow I'm

calling the HR dept. of my husband's company. I feel like I'm being

deprived of the initial level of consideration for the jaw surgery

(which means I have one less level of appeal than I'm entitled to).

I had hoped to initiate the appeal myself & send in a letter from me

in addition to a letter from the doctor. I'm not even positive if

I'm in appeals or not now, because every time I call I get a

different person saying something else!

My surgery is probably at least 6 months away. Since your surgery

is so close, they probably have to act on yours much faster

(assuming they admit they have your paperwork!). I'll be interested

in seeing what happens with you and wish you the best! If they deny

you, I think you can usually still appeal a 2nd level (if you're

under a self-insured plan), by appealing to a special dept. of your

Company (not UHC again). I'm just going to keep on fighting and

fighting. Hope you have better luck than me so far!

> Clay,

> Thank you, but I am going to be sweating about this over the next

> few weeks since I dont't have any idea whether they are going to

> cover this or not (surgery is set for 5/21 - I have appealed their

> original decision and now am waiting for a response). I am hoping

> everything goes smoothly with the appeal and extra documentation -

> if not, on to the next step (may be asking a few questions about

> that later if I get another no)

>

[Guest guest]

Hi . I have United Healthcare too, and am currently fighting

with them over covering the surgery. I'm so frustrated I think I'm

going to explode. They tend to loose paperwork a lot and everytime

you call them, they give you a different answer about what is going

on. Half the people there don't know what's going on!

My case is so messed up I don't know how it will ever get straight.

I had two different predetermination cases sent in by my doctor.

(so they would not get confused). The first was for a trigger point

injection on a tendon on my face. The trigger point injection

paperwork sent in by my doctor must have mentioned the jaw

(orognathic) surgery, but the intent was clearly not to try to get a

pretermination on coverage of the jaw surgery yet, only the trigger

point. Then the second predetermination request was sent a few

weeks later for the jaw surgery. (had to send the second one in

twice, because they lost the first, of coarse). They paid for my

trigger point procedure which I've already had. But they've told my

me on the phone they are denying the jaw surgery. I never got a

letter saying that or anything explaining appeals. I called UHC to

get them to mail the supposed denial of jaw surgery again. They

sent the trigger point letter instead (which I had already gotten a

few months ago). I think they are confused and think that the 1st

thing request was for trigger point & jaw surgery, and that the 2nd

thing is an appeal for jaw surgery.

I'm making calls nearly every day to try to fix this. Tomorrow I'm

calling the HR dept. of my husband's company. I feel like I'm being

deprived of the initial level of consideration for the jaw surgery

(which means I have one less level of appeal than I'm entitled to).

I had hoped to initiate the appeal myself & send in a letter from me

in addition to a letter from the doctor. I'm not even positive if

I'm in appeals or not now, because every time I call I get a

different person saying something else!

My surgery is probably at least 6 months away. Since your surgery

is so close, they probably have to act on yours much faster

(assuming they admit they have your paperwork!). I'll be interested

in seeing what happens with you and wish you the best! If they deny

you, I think you can usually still appeal a 2nd level (if you're

under a self-insured plan), by appealing to a special dept. of your

Company (not UHC again). I'm just going to keep on fighting and

fighting. Hope you have better luck than me so far!

> Clay,

> Thank you, but I am going to be sweating about this over the next

> few weeks since I dont't have any idea whether they are going to

> cover this or not (surgery is set for 5/21 - I have appealed their

> original decision and now am waiting for a response). I am hoping

> everything goes smoothly with the appeal and extra documentation -

> if not, on to the next step (may be asking a few questions about

> that later if I get another no)

>

[Guest guest]

Hi . I have United Healthcare too, and am currently fighting

with them over covering the surgery. I'm so frustrated I think I'm

going to explode. They tend to loose paperwork a lot and everytime

you call them, they give you a different answer about what is going

on. Half the people there don't know what's going on!

My case is so messed up I don't know how it will ever get straight.

I had two different predetermination cases sent in by my doctor.

(so they would not get confused). The first was for a trigger point

injection on a tendon on my face. The trigger point injection

paperwork sent in by my doctor must have mentioned the jaw

(orognathic) surgery, but the intent was clearly not to try to get a

pretermination on coverage of the jaw surgery yet, only the trigger

point. Then the second predetermination request was sent a few

weeks later for the jaw surgery. (had to send the second one in

twice, because they lost the first, of coarse). They paid for my

trigger point procedure which I've already had. But they've told my

me on the phone they are denying the jaw surgery. I never got a

letter saying that or anything explaining appeals. I called UHC to

get them to mail the supposed denial of jaw surgery again. They

sent the trigger point letter instead (which I had already gotten a

few months ago). I think they are confused and think that the 1st

thing request was for trigger point & jaw surgery, and that the 2nd

thing is an appeal for jaw surgery.

I'm making calls nearly every day to try to fix this. Tomorrow I'm

calling the HR dept. of my husband's company. I feel like I'm being

deprived of the initial level of consideration for the jaw surgery

(which means I have one less level of appeal than I'm entitled to).

I had hoped to initiate the appeal myself & send in a letter from me

in addition to a letter from the doctor. I'm not even positive if

I'm in appeals or not now, because every time I call I get a

different person saying something else!

My surgery is probably at least 6 months away. Since your surgery

is so close, they probably have to act on yours much faster

(assuming they admit they have your paperwork!). I'll be interested

in seeing what happens with you and wish you the best! If they deny

you, I think you can usually still appeal a 2nd level (if you're

under a self-insured plan), by appealing to a special dept. of your

Company (not UHC again). I'm just going to keep on fighting and

fighting. Hope you have better luck than me so far!

> Clay,

> Thank you, but I am going to be sweating about this over the next

> few weeks since I dont't have any idea whether they are going to

> cover this or not (surgery is set for 5/21 - I have appealed their

> original decision and now am waiting for a response). I am hoping

> everything goes smoothly with the appeal and extra documentation -

> if not, on to the next step (may be asking a few questions about

> that later if I get another no)

>

[Guest guest]

Write down the name of every person with whom you talk. if it is

possible, tape every conversation you have ( a hookup to do that is

not expensive; whether it is legal depends on the laws of the

state/province/parish in which you live). But you need a documented

record of these conversations. If you can do them by e-mail, so much

the better, because you will then have a record available.

Some insurance companies can be soooo slippery. Mine was fine, did

well by me, and I had no problems. But I know many others who have

not been so fortunate.

Get the help of your surgeon in every way in which he/she will do it.

Send ceph x-rays, molds, photos of molds, drawings, or copies of

them, and every other documentation you can think of.

Correction: since they lose things, send copies!!!

Send them by registered, certified mail, so you get a receipt.

> > Clay,

> > Thank you, but I am going to be sweating about this over the next

> > few weeks since I dont't have any idea whether they are going to

> > cover this or not (surgery is set for 5/21 - I have appealed

their

> > original decision and now am waiting for a response). I am hoping

> > everything goes smoothly with the appeal and extra documentation -

> > if not, on to the next step (may be asking a few questions about

> > that later if I get another no)

> >

[Guest guest]

Write down the name of every person with whom you talk. if it is

possible, tape every conversation you have ( a hookup to do that is

not expensive; whether it is legal depends on the laws of the

state/province/parish in which you live). But you need a documented

record of these conversations. If you can do them by e-mail, so much

the better, because you will then have a record available.

Some insurance companies can be soooo slippery. Mine was fine, did

well by me, and I had no problems. But I know many others who have

not been so fortunate.

Get the help of your surgeon in every way in which he/she will do it.

Send ceph x-rays, molds, photos of molds, drawings, or copies of

them, and every other documentation you can think of.

Correction: since they lose things, send copies!!!

Send them by registered, certified mail, so you get a receipt.

> > Clay,

> > Thank you, but I am going to be sweating about this over the next

> > few weeks since I dont't have any idea whether they are going to

> > cover this or not (surgery is set for 5/21 - I have appealed

their

> > original decision and now am waiting for a response). I am hoping

> > everything goes smoothly with the appeal and extra documentation -

> > if not, on to the next step (may be asking a few questions about

> > that later if I get another no)

> >

[Guest guest]

Good information and advice! My surgeon sent in a ton of stuff the

day before I sent in my appeal letter (faxed and mailed). I will

check into the taping thing (I don't think it is legal in this

state, but I will double check) and will try to get ahold of an

e-mail address for them to get everything in writing.

Thanks

> > > Clay,

> > > Thank you, but I am going to be sweating about this over the

next

> > > few weeks since I dont't have any idea whether they are going

to

> > > cover this or not (surgery is set for 5/21 - I have appealed

> their

> > > original decision and now am waiting for a response). I am

hoping

> > > everything goes smoothly with the appeal and extra

documentation -

>

> > > if not, on to the next step (may be asking a few questions

about

> > > that later if I get another no)

> > >

[Guest guest]

Good information and advice! My surgeon sent in a ton of stuff the

day before I sent in my appeal letter (faxed and mailed). I will

check into the taping thing (I don't think it is legal in this

state, but I will double check) and will try to get ahold of an

e-mail address for them to get everything in writing.

Thanks

> > > Clay,

> > > Thank you, but I am going to be sweating about this over the

next

> > > few weeks since I dont't have any idea whether they are going

to

> > > cover this or not (surgery is set for 5/21 - I have appealed

> their

> > > original decision and now am waiting for a response). I am

hoping

> > > everything goes smoothly with the appeal and extra

documentation -

>

> > > if not, on to the next step (may be asking a few questions

about

> > > that later if I get another no)

> > >