The validity of the guidelines was also ascertained by determining their completeness and correctness. Enrique Cardenas, insurance specialist for Dr. McGann, works with patients to get their surgeries paid for. Surgery can improve breathing, chewing and speaking. Orthognathic surgery can boost self-esteem and provide comfort after years of pain and insecurity. UHC is an outlier. Insurance; Common Problems; FAQ; Blog; Contact Us; Search. For example, Aetna [ 1] considers orthognathic surgery medically necessary in cases where facial skeletal abnormalities contribute to sleep apnea or other breathing problems that cannot be corrected non … Insurance & Payment Options; Pre and Post Op Instructions; Referring Doctors; Contact Us; Maxillofacial Surgery. Aetna) consider jaw surgeries to be “medically necessary” if the skeletal irregularities cause sleep apnea disorder, … Age. • Orthognathic surgery for cosmetic reasons is not covered. A surgeon's cost for jaw surgery may vary based on his or her experience, the type of procedure used, as well as geographic office location. Orthognathic (Jaw) Surgery. Orthognathic surgery is the revision of the upper jaw (maxilla) and/or the lower jaw (mandible) by ostectomy, osteotomy or osteoplasty, to correct skeletal anomalies, malformations or malocclusions. I decided to go to a recent OMS that I took my daughter to for her wisdom teeth removal. UHC is an outlier. Schedule a Consultation. As for when, specialists hold different opinions. Getting insurance to pay for orthognathic surgery means documenting the necessity in advance, and sometimes submitting the claim to both your medical and dental plan – if you have one. The current study proves that no insurance guideline is in agreement with the criteria of a 'prudent provider'. Patients covered by health insurance typically need to copay as low as a $100 copay, or as much as $5,000, provided that insurance company only covers a percentage of the surgery… More about Orthognathic Surgery. Most health insurance policies, surch as those offered by Aetna, Anthem, or other providers, tend to have reasonable guidelines for jaw surgery coverage. Patients were included in the control group if they met the criteria of a 'prudent provider,' crafted for this study. Copyright © 2020 Elsevier B.V. or its licensors or contributors. Your surgeon will work closely with the referring dentist and orthodontist to determine if you are a candidate for corrective jaw surgery. Orthognathic surgery is a class of surgical procedures designed to realign the maxillofacial skeletal structures with each other and with the other craniofacial structures. Recently Asked. To evaluate the validity, we calculated the approval and denial rates of the 5 guidelines when we used them to assess the medical necessity for a control group of carefully selected patients. Orthognathic Surgery is also successful in treating Obstructive Sleep Apnea and is the only surgical procedure available to provide effective relief from Sleep Disordered Breathing and Sleep Apnea. Show Questions. The validity of the guidelines was also ascertained by determining their completeness and correctness. If you can prove that the surgery is essential to your wellbeing and health your insurance company should pay for all or some of your treatment. The purpose of this study was to assess the validity of orthognathic surgery guidelines used by the major American medical insurance companies. Pros. Typically, a patient will be seen by one of our orthodontists, who will discuss a treatment plan. Orthognathic surgery refers to the surgical correction needed to fix substantial abnormalities of the maxilla (upper jaw), the mandible (lower jaw), or both. Additional evaluations demonstrate that the private insurance guidelines are incomplete and, at times ,incorrect. Orthognathic surgery is designed to improve basic orofacial functions such as breathing, chewing and speaking and most patients who receive treatment return home on the day of surgery. Orthognathic surgery is covered by health insurance in some cases. The jawbones are repositioned to a more “normal” position; bone may be added, removed, or reshaped. Orthognathic Surgery Orthognathic Surgery Means: To straighten the jaws by way of surgery (ortho = straight, gnathic = jaw) What is it? By continuing you agree to the use of cookies. Cost and Insurance Without health insurance, according to CostHelper, orthognathic surgery cost in the United States can range from about $20,000 to well over $40,000. 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