How to get jaw surgery covered by insurance?

ByHelen Russell

Jaw surgeries are generally meant to correct facial imbalances by allowing the jaw bones to fit together correctly in shape. These surgeries have gained much more popularity since the world witnessed a large wave of technological advancement.

In this article, we shall discuss how a patient can make the insurance pay for their jaw surgery. Let’s take a look.

How To Get Jaw Surgery Covered By Insurance?

It is important to understand that most insurance companies will not cover jaw surgery if it’s merely for facial enhancement. Facial enhancement can include reshaping or enhancing the size of the chin to make the face look more proportionate.

However, there could be instances where jaw surgery becomes medically necessary. Jaw surgery becomes a medical necessity when it is done to treat a non-biting injury, illness, disease, or deformation of the jaw area after an injury.

Criteria

To get jaw surgery covered by the health insurance company, the patient is required to tick off any one of the below-mentioned criteria:

  1. Treatment of malocclusion that contributes significantly to disorders unresponsive to 4 months of non-surgical therapy
  2. Speech abnormality
  3. Malnutrition
  4. When the patient needs to recover from a significant accidental injury, infection, or tumor.
  5. Inhaling and exhaling from the mouth.
  6. Obstructive sleep apnea diagnosis along with proof of treatment.
  7. When the patient is required to go through significant congenital (visible at birth) deformity correction.
  8. Diagnosis of Temporomandibular Joint (TMJ) syndrome treatment caused by malocclusion. 
  9. Persistent symptoms and signs for at least four months.
  10.  Conservative treatments are ineffective for at least four months. 
  11. Difficulty in feeding and swallowing food.
How to get jaw surgery covered by insurance?

Get A Letter From The Doctor

The easiest approach to getting health insurance for your jaw surgery and the associated orthodontic work is to have your surgeon write a note of medical necessity beforehand.

Send the document for pre-certification to the issuing company, as many of these components should be included in the letter of medical necessity. Here is what all

  • Patient name and member ID number.
  • SOAP Notes (Subjective, Objective, Assessment, Procedure).
  • Summary of medical history and diagnosis.
  • Reason/Rationale for Treatment (How it will fix the problem and more).
  • Proposed operative report- Appropriate ICD-10 and CPT codes and Prognosis or expected outcome.

How To Prepare For Jaw Surgery?

  • Take some time off

Plan your off time before the surgery so you do not worry about taking leave. Depending on your condition, you might be able to go back to work one to three weeks after surgery. The jaw initially takes six weeks to recover before taking nine to twelve months to do so completely.

  • Quit smoking

You must be aware that smoking can raise the possibility of surgical problems by delaying post-operative recovery. Also, gum diseases may potentially result from it or become worse. Medical experts suggest giving up on smoking as early as possible. Ask your primary healthcare practitioner to help you develop a strategy to stop smoking.

  • Inform your doctor

Ensure your surgeon knows any prescription or over-the-counter medications, herbal supplements, or vitamins you take. Your doctor might instruct you to stop taking some of them a few weeks before surgery.

  • Realistic expectations

Having realistic expectations regarding the results and recovery process is equally important. The patient won’t be able to chew at first after surgery. Sometimes, the jaw may be closed (immobilized) for around two weeks. Therefore, they must learn what to eat, how to eat, and how to maintain comfort.

Conclusion

So, to conclude, one will only get insurance for the surgery if it is a medical necessity and not for facial enhancement, which is not required medically.

We would advise our readers to talk with their doctor and insurance provider to get a clear picture of the terms and conditions regarding jaw surgery. Do not forget to check our website for more such informational content.

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