Guest guest Posted February 3, 2004 Report Share Posted February 3, 2004 Hello all, just found the site and wanted to introduce myself and ask a few questions. My name is , and I've know for a while that I'd have to have jaw surgery to correct an underbite (someday.. done growing, etc.). I put it off while in college mostly because I'd adapted and it wasn't causing me many problems. I've been having more problems with my jaw recently (age - 25) so it set me in action. So I saw the Orthodontist and Oral Surgeon, finding that I needed Lefort I (lower and maybe upper) at a cost of ~12.5k. I got the braces put on a few weeks ago and had the oral surgeon pre-certify the surgery. Here's the catch: pre-certification was denied. Even though my health plan covers oral surgery relating to " congenital abnormalities of the jaw " and " charges in connection with TMJ problems " . This completely caught me off guard. They denied it because it was found to be " developmental " by the reviewing doctor. I'm looking into the best way to appeal it now. So here's my question: Anyone else have a claim denied in this or a similiar way? Also, how much more can I espect to pay for the 1-2 day hospital stay? Just trying to set up some kind of plan for worst case, even though I cannot really afford to pay the full cost myself. Thanks for reading. Quote Link to comment Share on other sites More sharing options...
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