INSURANCE

The Final Insurance Surgery Approval Letter

The most important information about jaw surgery is how to pay for it. For most Americans, that means health insurance. Here's what you need to know:

1. Your top priority is getting and keeping insurance approval. There are several steps to the process. 

Pre-surgery approval - This is the first round of paperwork, done before pre-surgery braces are placed and treatments agreed to. It took months and over 180 pages of medical records to get my insurance (Blue Cross Blue Shield) to agree to pay for my jaw surgery. I was denied twice before finally winning initial insurance approval. 

Post braces surgery re-approval - I had 6 months of Invisalign braces before surgery to get my teeth lined up for surgery. The goal during this period is to keep the same insurance company with the same level of benefits. During my 6 months of pre-surgery braces, my husband's employer-provided health insurance came up for annual review. There was a chance his employer would change companies or covered benefits. Luckily, that did not happen. But it easily could have. 

 I received surgical insurance approval before beginning braces, which did not cover the cost of the braces. Braces were partially covered by a different dental insurance plan. I refused to begin brace treatment without insurance approval for the end goal, jaw surgery. After pre-surgery treatment, my insurance needed to re-authorize their approval for jaw surgery. 
DENIED. 
WTF???!!

After weeks of jumping through insurance appeals, my surgeon met with an insurance surgeon to explain why I needed surgery. I dunno what went down (I like to imagine my mild-mannered doc using all the swears), all I know is the insurance side apologized to my surgeon, saying my case should have never been repeatedly denied and they didn't know why that happened. My bad, etc. etc. 

If that wouldn't have worked, I was mentally preparing to find a lawyer specializing in health insurance to fight them in court. At that point I was $5000 into Invisalign treatment specific to receiving jaw surgery, based on the health insurance company agreeing to the cover the procedure. To deny treatment at that point, was outrageous. I already had the state health insurance board on speed dial, ready to file a formal complaint with the state against my insurance company. 
Luckily, Blue Cross Blue Shield changed their mind and did the right thing in the end without going to court or tangling with state regulators. Good for them.  

With final WRITTEN approval in hand at the surgeon's office, (I refused to schedule surgery until we had the deal in ink), I contacted the hospital and the anesthesia office to make sure they each had a copy of the approval letter and they agreed to accept payment. At that point, I was making no assumptions. 

Take Away - Your surgeon's office will have staff trained to request pre-surgery insurance approvals. They will need lists of contact information for all your doctors to request records. They will deal with your insurance company, so be very nice and accommodating to them. In my case, I was the one who went from office to office physically collecting health records, then depositing them at the surgeon's office.  If I wouldn't have done that, I can't imagine how long my insurance approval process would have drug out. Do whatever you have to do to make the insurance nightmare work for you.