Re: I just LOVE the insurance hassle....not!

[Guest guest]

i would try and wait until you have your new coverage... if they say no,

t hen u r rite back where u started, but if they say yes.... hey u save

ur self some $$$$$$. I know waiting for the surgery to happen is mind

boggling... but $6000 is alot of money

I just LOVE the insurance

hassle....not!

Hi Everyone,

Just a quick question. Has anyone ever gotten approval for this

surgery even though it is specifically listed under general

exclusions in your policy? I have just under 3 weeks to go before a

surgery date of 1/27, which my husband's COBRA coverage was supposed

to cover. The insurance company is still giving me the runaround,

and then of course, January started, and now our out of pocket max

for the year is $6000 instead of $3000, so I have to pay an

additional $3000 for my surgery if it is even approved. (Out of

network surgeon (there are no in-network surgeons in my area), he's

only covered at 65%, and the hospital is at 85%) So....(are you all

following me here:-)?) my insurance plan through my employer starts

on Feb. 1st. It specifically excludes " Orthognathic reconstructive

surgery " . I spoke to the insurance agent, and he told me that

sometimes even excluded things get covered. He has offered to help

in any way possible. I just don't know whether to go through with

the surgery in January (if it even gets approved), or to save the

$6000 and wait until February to try.

Anyone have any suggestions, or experience with this?

_____

[Guest guest]

i would try and wait until you have your new coverage... if they say no,

t hen u r rite back where u started, but if they say yes.... hey u save

ur self some $$$$$$. I know waiting for the surgery to happen is mind

boggling... but $6000 is alot of money

I just LOVE the insurance

hassle....not!

Hi Everyone,

Just a quick question. Has anyone ever gotten approval for this

surgery even though it is specifically listed under general

exclusions in your policy? I have just under 3 weeks to go before a

surgery date of 1/27, which my husband's COBRA coverage was supposed

to cover. The insurance company is still giving me the runaround,

and then of course, January started, and now our out of pocket max

for the year is $6000 instead of $3000, so I have to pay an

additional $3000 for my surgery if it is even approved. (Out of

network surgeon (there are no in-network surgeons in my area), he's

only covered at 65%, and the hospital is at 85%) So....(are you all

following me here:-)?) my insurance plan through my employer starts

on Feb. 1st. It specifically excludes " Orthognathic reconstructive

surgery " . I spoke to the insurance agent, and he told me that

sometimes even excluded things get covered. He has offered to help

in any way possible. I just don't know whether to go through with

the surgery in January (if it even gets approved), or to save the

$6000 and wait until February to try.

Anyone have any suggestions, or experience with this?

_____

[Guest guest]

i would try and wait until you have your new coverage... if they say no,

t hen u r rite back where u started, but if they say yes.... hey u save

ur self some $$$$$$. I know waiting for the surgery to happen is mind

boggling... but $6000 is alot of money

I just LOVE the insurance

hassle....not!

Hi Everyone,

Just a quick question. Has anyone ever gotten approval for this

surgery even though it is specifically listed under general

exclusions in your policy? I have just under 3 weeks to go before a

surgery date of 1/27, which my husband's COBRA coverage was supposed

to cover. The insurance company is still giving me the runaround,

and then of course, January started, and now our out of pocket max

for the year is $6000 instead of $3000, so I have to pay an

additional $3000 for my surgery if it is even approved. (Out of

network surgeon (there are no in-network surgeons in my area), he's

only covered at 65%, and the hospital is at 85%) So....(are you all

following me here:-)?) my insurance plan through my employer starts

on Feb. 1st. It specifically excludes " Orthognathic reconstructive

surgery " . I spoke to the insurance agent, and he told me that

sometimes even excluded things get covered. He has offered to help

in any way possible. I just don't know whether to go through with

the surgery in January (if it even gets approved), or to save the

$6000 and wait until February to try.

Anyone have any suggestions, or experience with this?

_____

[Guest guest]

Yes, I am going through the same thing right now. I was denied

because " the treatment for malocclusion is specifically excluded. " I

am going to appeal it. I have a friend who has the same insurance as

me and she is went through the same thing, had the same denial, she

appealed it and then got it covered. It did take her a long time to

get the approval though. I don't think your approval will be done by

your surgery date. You'll have to appeal it by writing a letter

telling them how you need the surgery because of such and such

reasons. Do not put self-esteem, dental, or cosmetic anywhere. Once

they see that, they'll deny it. This is medically necessary because

of such and such reasons. Call your insurance people and ask them

what exactly you need to do to appeal this. My health insurance out

of pocket expense doubled just like yours but not to $6,000. My in

network is 90/10 and out of network is 70/30. So the most I'll pay

each surgery is $3,500 with deductibles. Compared to last year it

would have been $1,500.

> Hi Everyone,

>

> Just a quick question. Has anyone ever gotten approval for this

> surgery even though it is specifically listed under general

> exclusions in your policy? I have just under 3 weeks to go before

a

> surgery date of 1/27, which my husband's COBRA coverage was

supposed

> to cover. The insurance company is still giving me the runaround,

> and then of course, January started, and now our out of pocket max

> for the year is $6000 instead of $3000, so I have to pay an

> additional $3000 for my surgery if it is even approved. (Out of

> network surgeon (there are no in-network surgeons in my area), he's

> only covered at 65%, and the hospital is at 85%) So....(are you all

> following me here:-)?) my insurance plan through my employer

starts

> on Feb. 1st. It specifically excludes " Orthognathic reconstructive

> surgery " . I spoke to the insurance agent, and he told me that

> sometimes even excluded things get covered. He has offered to help

> in any way possible. I just don't know whether to go through with

> the surgery in January (if it even gets approved), or to save the

> $6000 and wait until February to try.

>

> Anyone have any suggestions, or experience with this?

>

>

[Guest guest]

Yes, I am going through the same thing right now. I was denied

because " the treatment for malocclusion is specifically excluded. " I

am going to appeal it. I have a friend who has the same insurance as

me and she is went through the same thing, had the same denial, she

appealed it and then got it covered. It did take her a long time to

get the approval though. I don't think your approval will be done by

your surgery date. You'll have to appeal it by writing a letter

telling them how you need the surgery because of such and such

reasons. Do not put self-esteem, dental, or cosmetic anywhere. Once

they see that, they'll deny it. This is medically necessary because

of such and such reasons. Call your insurance people and ask them

what exactly you need to do to appeal this. My health insurance out

of pocket expense doubled just like yours but not to $6,000. My in

network is 90/10 and out of network is 70/30. So the most I'll pay

each surgery is $3,500 with deductibles. Compared to last year it

would have been $1,500.

> Hi Everyone,

>

> Just a quick question. Has anyone ever gotten approval for this

> surgery even though it is specifically listed under general

> exclusions in your policy? I have just under 3 weeks to go before

a

> surgery date of 1/27, which my husband's COBRA coverage was

supposed

> to cover. The insurance company is still giving me the runaround,

> and then of course, January started, and now our out of pocket max

> for the year is $6000 instead of $3000, so I have to pay an

> additional $3000 for my surgery if it is even approved. (Out of

> network surgeon (there are no in-network surgeons in my area), he's

> only covered at 65%, and the hospital is at 85%) So....(are you all

> following me here:-)?) my insurance plan through my employer

starts

> on Feb. 1st. It specifically excludes " Orthognathic reconstructive

> surgery " . I spoke to the insurance agent, and he told me that

> sometimes even excluded things get covered. He has offered to help

> in any way possible. I just don't know whether to go through with

> the surgery in January (if it even gets approved), or to save the

> $6000 and wait until February to try.

>

> Anyone have any suggestions, or experience with this?

>

>

[Guest guest]

Yes, I am going through the same thing right now. I was denied

because " the treatment for malocclusion is specifically excluded. " I

am going to appeal it. I have a friend who has the same insurance as

me and she is went through the same thing, had the same denial, she

appealed it and then got it covered. It did take her a long time to

get the approval though. I don't think your approval will be done by

your surgery date. You'll have to appeal it by writing a letter

telling them how you need the surgery because of such and such

reasons. Do not put self-esteem, dental, or cosmetic anywhere. Once

they see that, they'll deny it. This is medically necessary because

of such and such reasons. Call your insurance people and ask them

what exactly you need to do to appeal this. My health insurance out

of pocket expense doubled just like yours but not to $6,000. My in

network is 90/10 and out of network is 70/30. So the most I'll pay

each surgery is $3,500 with deductibles. Compared to last year it

would have been $1,500.

> Hi Everyone,

>

> Just a quick question. Has anyone ever gotten approval for this

> surgery even though it is specifically listed under general

> exclusions in your policy? I have just under 3 weeks to go before

a

> surgery date of 1/27, which my husband's COBRA coverage was

supposed

> to cover. The insurance company is still giving me the runaround,

> and then of course, January started, and now our out of pocket max

> for the year is $6000 instead of $3000, so I have to pay an

> additional $3000 for my surgery if it is even approved. (Out of

> network surgeon (there are no in-network surgeons in my area), he's

> only covered at 65%, and the hospital is at 85%) So....(are you all

> following me here:-)?) my insurance plan through my employer

starts

> on Feb. 1st. It specifically excludes " Orthognathic reconstructive

> surgery " . I spoke to the insurance agent, and he told me that

> sometimes even excluded things get covered. He has offered to help

> in any way possible. I just don't know whether to go through with

> the surgery in January (if it even gets approved), or to save the

> $6000 and wait until February to try.

>

> Anyone have any suggestions, or experience with this?

>

>

[Guest guest]

First, are you filing under your MEDICAL policy? NOT DENTAL.

Second, ask your surgeon's office for help.

Third, see if there are other grounds: apnea, repair of skeletal

dysplasia or congenital defect, etc., on which it might be covered.

Fourth: ask for review by a panel of oral and maxillofacial surgeons.

Fifth: Send every communication by certified, return receipt

requested mail, and get the name and address and phone number of

every person with whom you speak by telephone. Get everything you can

in writing, and hang on to it all.

Cammie

> Hi Everyone,

>

> Just a quick question. Has anyone ever gotten approval for this

> surgery even though it is specifically listed under general

> exclusions in your policy? I have just under 3 weeks to go before

a

> surgery date of 1/27, which my husband's COBRA coverage was

supposed

> to cover. The insurance company is still giving me the runaround,

> and then of course, January started, and now our out of pocket max

> for the year is $6000 instead of $3000, so I have to pay an

> additional $3000 for my surgery if it is even approved. (Out of

> network surgeon (there are no in-network surgeons in my area), he's

> only covered at 65%, and the hospital is at 85%) So....(are you all

> following me here:-)?) my insurance plan through my employer

starts

> on Feb. 1st. It specifically excludes " Orthognathic reconstructive

> surgery " . I spoke to the insurance agent, and he told me that

> sometimes even excluded things get covered. He has offered to help

> in any way possible. I just don't know whether to go through with

> the surgery in January (if it even gets approved), or to save the

> $6000 and wait until February to try.

>

> Anyone have any suggestions, or experience with this?

>

>

[Guest guest]

First, are you filing under your MEDICAL policy? NOT DENTAL.

Second, ask your surgeon's office for help.

Third, see if there are other grounds: apnea, repair of skeletal

dysplasia or congenital defect, etc., on which it might be covered.

Fourth: ask for review by a panel of oral and maxillofacial surgeons.

Fifth: Send every communication by certified, return receipt

requested mail, and get the name and address and phone number of

every person with whom you speak by telephone. Get everything you can

in writing, and hang on to it all.

Cammie

> Hi Everyone,

>

> Just a quick question. Has anyone ever gotten approval for this

> surgery even though it is specifically listed under general

> exclusions in your policy? I have just under 3 weeks to go before

a

> surgery date of 1/27, which my husband's COBRA coverage was

supposed

> to cover. The insurance company is still giving me the runaround,

> and then of course, January started, and now our out of pocket max

> for the year is $6000 instead of $3000, so I have to pay an

> additional $3000 for my surgery if it is even approved. (Out of

> network surgeon (there are no in-network surgeons in my area), he's

> only covered at 65%, and the hospital is at 85%) So....(are you all

> following me here:-)?) my insurance plan through my employer

starts

> on Feb. 1st. It specifically excludes " Orthognathic reconstructive

> surgery " . I spoke to the insurance agent, and he told me that

> sometimes even excluded things get covered. He has offered to help

> in any way possible. I just don't know whether to go through with

> the surgery in January (if it even gets approved), or to save the

> $6000 and wait until February to try.

>

> Anyone have any suggestions, or experience with this?

>

>

[Guest guest]

First, are you filing under your MEDICAL policy? NOT DENTAL.

Second, ask your surgeon's office for help.

Third, see if there are other grounds: apnea, repair of skeletal

dysplasia or congenital defect, etc., on which it might be covered.

Fourth: ask for review by a panel of oral and maxillofacial surgeons.

Fifth: Send every communication by certified, return receipt

requested mail, and get the name and address and phone number of

every person with whom you speak by telephone. Get everything you can

in writing, and hang on to it all.

Cammie

> Hi Everyone,

>

> Just a quick question. Has anyone ever gotten approval for this

> surgery even though it is specifically listed under general

> exclusions in your policy? I have just under 3 weeks to go before

a

> surgery date of 1/27, which my husband's COBRA coverage was

supposed

> to cover. The insurance company is still giving me the runaround,

> and then of course, January started, and now our out of pocket max

> for the year is $6000 instead of $3000, so I have to pay an

> additional $3000 for my surgery if it is even approved. (Out of

> network surgeon (there are no in-network surgeons in my area), he's

> only covered at 65%, and the hospital is at 85%) So....(are you all

> following me here:-)?) my insurance plan through my employer

starts

> on Feb. 1st. It specifically excludes " Orthognathic reconstructive

> surgery " . I spoke to the insurance agent, and he told me that

> sometimes even excluded things get covered. He has offered to help

> in any way possible. I just don't know whether to go through with

> the surgery in January (if it even gets approved), or to save the

> $6000 and wait until February to try.

>

> Anyone have any suggestions, or experience with this?

>

>

[Guest guest]

Thanks, Cammie,

1st) Yep, it's the medical unfortunately.

2nd) I will do that. The girl I am dealing with at the surgeon's

office doesn't seem to have much experience with CIGNA. Maybe

someone else there can help me.

3rd, 4th and 5th) Great ideas, I will try that.

This is so frustrating, and I can choose to say " forget it " and still

register for classes this semester until Monday. (I took this

semester off for the surgery). I am just ready to do that. But then

again that is what they are hoping on. I don't want to get the

braces taken off in August (like they were supposed to be) without

getting the surgery done, because then I know I will never get it

done. I also don't want to end up keeping them on for an extra year!

Ok, enough whining, I will just have to deal with whatever happens

and go on. I will keep you all posted,

> > Hi Everyone,

> >

> > Just a quick question. Has anyone ever gotten approval for this

> > surgery even though it is specifically listed under general

> > exclusions in your policy? I have just under 3 weeks to go

before

> a

> > surgery date of 1/27, which my husband's COBRA coverage was

> supposed

> > to cover. The insurance company is still giving me the

runaround,

> > and then of course, January started, and now our out of pocket

max

> > for the year is $6000 instead of $3000, so I have to pay an

> > additional $3000 for my surgery if it is even approved. (Out of

> > network surgeon (there are no in-network surgeons in my area),

he's

> > only covered at 65%, and the hospital is at 85%) So....(are you

all

> > following me here:-)?) my insurance plan through my employer

> starts

> > on Feb. 1st. It specifically excludes " Orthognathic

reconstructive

> > surgery " . I spoke to the insurance agent, and he told me that

> > sometimes even excluded things get covered. He has offered to

help

> > in any way possible. I just don't know whether to go through

with

> > the surgery in January (if it even gets approved), or to save the

> > $6000 and wait until February to try.

> >

> > Anyone have any suggestions, or experience with this?

> >

> >

[Guest guest]

as long as your physician writes down a medical diagnosis and not

emotional reasons etc, it should be fine. i have BCBS and they are

paying 80% of the docs fee (he is not intheir group) and 100% of the

hospital bill, however it also states in my policy that after I pay the

first $1000 out of pocket expense they will pick up 100% of all bills

(including the docs fee), which is great. they did deny the chin which

is truely cosmetic now matter what he writes, but the upper and lower

have been approved

wendy

Re: I just LOVE the insurance

hassle....not!

I must say, that with my upcoming surgery less than 2 months away,

this board has been great AND terrible at the same time. Kidding of

course. The experiences I've read have been so informative...however,

this business with the insurance claims are miserable. My surgeons'

office just called for pre-cert on Tues 1/6. I have UHC and based on

what I've read, I'm almost expecting them to DENY me (upper & lower).

However, after reading my coverage manual, the exclusion reads as

follows: " Plastic surgery, reconstructive surgery, cosmetic surgery,

or other services and supplies that improve, alter, or enhance

appearance, whether or not for psychological or emotional reasons,

EXCEPT TO THE EXTENT IT IS NEEDED TO IMPROVE THE FUNCTION OF A BODY

PART or repair an injury that occurs while the person is covered

under the plan. "

Based on how the above reads, I would assume that I should be

ok...but was just wondering if anyone's manual read the same and what

their experience was with UHC? Please advise?

Thanks,

> > Hi Everyone,

> >

> > Just a quick question. Has anyone ever gotten approval for this

> > surgery even though it is specifically listed under general

> > exclusions in your policy? I have just under 3 weeks to go

before

> a

> > surgery date of 1/27, which my husband's COBRA coverage was

> supposed

> > to cover. The insurance company is still giving me the

runaround,

> > and then of course, January started, and now our out of pocket

max

> > for the year is $6000 instead of $3000, so I have to pay an

> > additional $3000 for my surgery if it is even approved. (Out of

> > network surgeon (there are no in-network surgeons in my area),

> he's

> > only covered at 65%, and the hospital is at 85%) So....(are you

> all

> > following me here:-)?) my insurance plan through my employer

> starts

> > on Feb. 1st. It specifically excludes " Orthognathic

> reconstructive

> > surgery " . I spoke to the insurance agent, and he told me that

> > sometimes even excluded things get covered. He has offered to

> help

> > in any way possible. I just don't know whether to go through

with

> > the surgery in January (if it even gets approved), or to save the

> > $6000 and wait until February to try.

> >

> > Anyone have any suggestions, or experience with this?

> >

> >

_____