Health Insurance and Jaw Surgery

The fees for orthognathic surgery are typically submitted to your medical insurance company for payment.  We will submit a request for pre-approval of your procedure prior to your surgery.  With persistence and an extensive knowledge of our patient’s legal rights, we have been successful in assuring that our patients get the coverage they deserve based on their individual insurance plan.

 

We have chosen NOT to participate as “in-network” providers for any insurance company because their reimbursement fees simply do not allow us to provide the level of care that we do.

 

 

“Out–of–Network Providers”

If your insurance plan covers your care by “out-of-network” providers, they will typically provide payment for all of the hospital expenses and up to 80% of usual and customary surgical fees. The hospital and surgical fee coverage will vary with each insurance plan.

 

 

“In-Network Providers”

Surgeons who participate with insurance companies are considered “in -network providers”.  “In-network providers” are commonly not screened for proficiency.  The insurance companies rarely have any criteria or data to indicate a doctor’s proficiency in corrective jaw surgery.  You may be referred to a surgeon with very little or no experience in jaw surgery.  If you do not have “out-of-network” privileges you may want to upgrade your insurance to a plan that covers care provided by “out-of-network” providers.  If you remain “in-network” and choose to interview an “in-network” provider, make sure to review the information contained in chapter 6, as your choice will determine the final outcome and safety of your treatment.  The intricate nature of this surgery requires a surgeon with substantial experience in jaw surgery as well as a surgeon who performs corrective jaw surgery on a regular basis.  It is important to know that if your insurance company cannot provide you with a competent and experienced surgeon, they must allow you to be treated by an “out-of-network” surgeon without it costing you more than your network obligation.

 

It is important that you provide our office with a copy of your insurance plan. With your permission, we will communicate with your insurance company on your behalf.