My Insurance DENIED My Double Jaw Surgery and It Costs $35,000 - Update on my Jaw Surgery Journey

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  • เผยแพร่เมื่อ 5 ก.ย. 2024

ความคิดเห็น • 87

  • @Craig_876
    @Craig_876 2 ปีที่แล้ว +9

    I’m about to do my double jaw surgery, my surgeon cost is 42,000 he’s out of network. The weird part is they required a deposit of 25,000. Is this normal? Even thou I have insurance.

    • @kyyahabdularchives
      @kyyahabdularchives  2 ปีที่แล้ว +6

      Im so glad I can actually answer this! So my surgery was finally approved and my surgeons cost was actually $20,000 ($10k for my Surgeon Dr. Wolgemuth and another $10k for his partner Dr. Madorsian). Even though this is out of network they approved him under the highest in-network benefits. Which is amazing. Even though I have insurance and its approved, I still had to pay the $20k up front to the surgeons office prior to surgery. After surgery my surgeons office will submit a claim to my insurance for the $20k and the insurance will send me a check for the $20k minus any deductibles. Keep in mind these costs exclude nights in the hospital which the insurance generally covers.
      Its normal for the surgeons office to ask for the money upfront. I assume its because they dont want to deal with the insurance companies and chasing them for their fees. $20k or $42k in your case is a lot of money so it makes sense Hopes this helps!

  • @ZiahsVlogs
    @ZiahsVlogs 2 ปีที่แล้ว +9

    Dealing with insurance can be such a nightmare! They legit refused to pay for my (Stage 4 Endo) Excision Surgery, we ended up paying it on our own! My surgery took 13hrs! They took out so much of my small intestines, resectioned my bladder and bowel, but they called it an elective surgery and still refused to pay! I cant stand them! 😑
    Cant wait till youre better honestly! 🤗

  • @anyaidigova
    @anyaidigova 2 ปีที่แล้ว +16

    I have Kaiser HMO Gold plan. My insurance covers my double jaw surgery. My copay is $340 & $0 deductible. I chose Kaiser specifically because my orthodontist recommended it & said that that’s all they do are surgeries. 😉

    • @kyyahabdularchives
      @kyyahabdularchives  2 ปีที่แล้ว +1

      Mine finally got approved! Glad yours was too!

    • @davishughes5992
      @davishughes5992 2 ปีที่แล้ว

      @@kyyahabdularchives how did you get it approved? Mine denies it

    • @alexisallen3860
      @alexisallen3860 2 ปีที่แล้ว

      @@CCain365 wow congratulations

    • @phuongngocnguyen617
      @phuongngocnguyen617 ปีที่แล้ว +1

      I'm about planning for jaw surgery my orthodontist recommended kaiser but they have 17 plans I don't know which one can cover can you plz give me some advice

    • @alexacoupet
      @alexacoupet ปีที่แล้ว +1

      @@CCain365 hey! Where do i get this plan? I can’t figure it out

  • @Grace_Zandile97
    @Grace_Zandile97 2 ปีที่แล้ว +1

    I was suppose to get in high school but it was denied also. Now I have to start the braces journey all over again for the preparation of the surgery

  • @musiccrazy5678
    @musiccrazy5678 2 ปีที่แล้ว +8

    I'm sorry you've had insurance problems. That's surprising to hear, I have Blue Cross and mine got approved right away. I'm wondering since you just started a new job how your time off will work? At my job you have to be with the company for 12 months before you can qualify of a leave/short term disability.
    Also I have ceramic (clear) braces. I drink coffee everyday and it isn't an issue!

    • @kyyahabdularchives
      @kyyahabdularchives  2 ปีที่แล้ว +1

      This new company has unlimited PTO so you take time when you need it which is nice. My surgeon said I should be okay to work after a week. Im going to try and apply again with BCBS I think they denied it bc I went through the continuity of care route.
      I wish they offered me the clear braces! 😭

    • @dess2015
      @dess2015 2 ปีที่แล้ว +1

      I have blue cross as well. Im waiting for approval / denial right now, but I’m kinda worried though because I don’t have any issues aside from an altered appearance :/

    • @Eva-su8bx
      @Eva-su8bx 2 ปีที่แล้ว

      you have blue cross , and it covered ?

    • @luluhoney1902
      @luluhoney1902 2 ปีที่แล้ว

      How much are they covering?

    • @bels9773
      @bels9773 2 ปีที่แล้ว

      Hi Sara I also have Blue cross. Did you do the double jaw surgery? was it 100% covered?

  • @JohnSmith-sj2dk
    @JohnSmith-sj2dk 3 หลายเดือนก่อน

    yeah, I tried 3 times, got close but no cigar, now flying to India for BiJaw next week (~$10k USD)

  • @PlMPinDlSTRESS
    @PlMPinDlSTRESS 2 ปีที่แล้ว +1

    My surgery was 50k I only had to pay 800 out of pocket. But I used my health fund that my company puts money into every month which is about 1000 a year to cover the rest.

  • @nobujak
    @nobujak 2 ปีที่แล้ว +2

    I am considering my double jaw surgery. Insurance coverage for the surgery is my primary concern. I carry Aetna and the benefit booklet clearly states that the plan does cover maxillofacial surgery and the associated hospital stays. But your story makes me think that they might refuse to cover the expenses. I am waiting to hear from my orthognathic clinic about what Aetna has to say.
    Aetna is generally generous compared to some other insurance companies, though.
    For braces, I carry MetLife and they do cover the cost but only for up to $1K. A quote I recently got from an orthodontist was $6,800, so my out-of-pocket expense just for braces would be $5,800.

    • @kyyahabdularchives
      @kyyahabdularchives  2 ปีที่แล้ว +1

      Aetna ended up covering it actually! Its BCBS that denied me

  • @tatianarodriguez9905
    @tatianarodriguez9905 2 ปีที่แล้ว +5

    So it sounds like your insurance acknowledged they would cover some of the cost AFTER your surgery, is that correct? I have my double jaw surgery in three months with a surgeon out of network (didn’t have a choice of one in-network). My insurance says they’ll cover some of the costs, but they won’t tell me how much until AFTER my surgery. Which I think is absolutely ridiculous.

    • @kyyahabdularchives
      @kyyahabdularchives  2 ปีที่แล้ว +2

      So they ended up pre approving and even though my doctor was out of network they agreed to treat him as an in network provider so I would only have to pay my deductible which Is $1,750. I do have 2 insurances so now it’s a fight of who is paying what 🙄. Also I had to pay my surgeon up front and now I’m waiting for reimbursement from insurance. Its all very silly the way these insurance companies work

  • @beaubunny4
    @beaubunny4 2 ปีที่แล้ว +5

    My double jaw surgery is scheduled for 1/26/22. I’m 28 and have an underbite too. Fingers crossed I get Invisalign afterwards, I’m sick of having braces 😬

  • @electricfaze
    @electricfaze 2 ปีที่แล้ว +2

    Ahhh I’m getting surgery this December! And ugh insurance sucks :( I hope it works out for you with your new insurance! I’m so annoyed united healthcare won’t cover my genioplasty because they consider it cosmetic ….. and I totally understand the whole getting a stable job if you want to pursue this whole jaw surgery journey. I ended up switching jobs and got new insurance. I was lucky though my surgeon accepted the new insurance. And warning for clear braces if you have the kind of brackets that need clear rubber bands to hold the wire they will TURN YELLOW. I’m an avid coffee drinker 😅 I actually wish I just got metal on top

    • @kyyahabdularchives
      @kyyahabdularchives  2 ปีที่แล้ว

      OMG I resonate with everything you just said. I ended up with the metal braces! They didn't offer me the clear ones sadly! We will likely get our surgery around the same time! I seriously think ill be doing mine during the holiday season! Now that I have my braces all thats left is to sort out this insurance bit! Aetna already approved it then I went to BCBS (HMO) who denied it and now I have a new job that is going to offer Aetna so I should be okay but fingers crossed I will find out the week of the 15th! I wish you the best of luck. Please pleaseee keep my posted!

    • @crashthelegend
      @crashthelegend 2 ปีที่แล้ว +1

      Most insurance think it is cosmetic because it has nothing to do with the jaw function. The genio is done to balance the face

    • @kyyahabdularchives
      @kyyahabdularchives  2 ปีที่แล้ว

      @@crashthelegend my initial insurance approved it, so im going back to aetna starting tomorrow

    • @tas8883
      @tas8883 2 ปีที่แล้ว

      Which insurance did you switch too

  • @debunklies9124
    @debunklies9124 2 ปีที่แล้ว +2

    I'm sorry that they did this to you, you should reapply and seek the help of a professional to help you in your application.

    • @kyyahabdularchives
      @kyyahabdularchives  2 ปีที่แล้ว

      Yeah Im in the process! Just trying to keep my hopes up and stay positive

  • @crashthelegend
    @crashthelegend 2 ปีที่แล้ว +5

    Change to united health care they cover it

    • @kyyahabdularchives
      @kyyahabdularchives  2 ปีที่แล้ว +2

      Aetna ended up approving it!

    • @jennifer9277
      @jennifer9277 2 ปีที่แล้ว

      I have UHC and they denied mine.

    • @jhongaytan155
      @jhongaytan155 2 ปีที่แล้ว

      On what base did they approved it ?
      Mine got denied 😭.

    • @jhongaytan155
      @jhongaytan155 2 ปีที่แล้ว

      @@jennifer9277 I did as well

  • @melaries1823
    @melaries1823 2 ปีที่แล้ว +4

    Bruh im going through the same thing. Im getting an upper jaw surgery for my class 3 maloclussion open bite and they said nope. Wtf. Theyll only cover part of the surgery not my braces which is a lot of money in my state. I have cigna, they are the worst stg.

    • @kyyahabdularchives
      @kyyahabdularchives  2 ปีที่แล้ว +1

      I LEGIT think all insurance companies are a scam! I will say Aetna is pretty good about their approvals which is why I am so happy I have them again. My braces aren't covered either! It's all just so expensive and I genuinely cannot wait for this process to be done because it feels like so much money is being spent when insurance should be covering it ALL! That whole no ortho over 19 is complete nonsense. I hope everything works out for you!

  • @expert1219
    @expert1219 2 ปีที่แล้ว +1

    Blue Cross denied my surgery. They say they do not cover any orthognatic surgeries

    • @kyyahabdularchives
      @kyyahabdularchives  2 ปีที่แล้ว

      blue cross is the WORST insurer. Aetna is the best (still horrible but better than the others)

    • @mc9474
      @mc9474 2 ปีที่แล้ว +1

      What blue cross is this? Must be a state specifically that doesn’t cover it because I’ve had blue cross New Mexico and Hawaii, both approved it immediately.

    • @bels9773
      @bels9773 ปีที่แล้ว

      @@mc9474 Can you tell me your malocclusion details? I’m worried that mine won’t be approved

  • @leeheat333
    @leeheat333 2 ปีที่แล้ว +1

    Man - I gotta say, I'm dealing with my Doctors office and they have been a PAIN about submitting the claim to my insurance company (Aetna). Apparently my claim was denied at first because they never ended up submitting my paperwork along with my claim. I'm truly hoping it gets approved this time around when they submit all my paperwork. If not idk how I'm going to go about this cause I already have the braces on and everything is already set for the surgery (was supposed to have it 4 months ago).

    • @kyyahabdularchives
      @kyyahabdularchives  2 ปีที่แล้ว +1

      Its so annoying dealing with all this insurance stuff. Even though my surgery was approved I had to pay $20k up front and even though I am 3 months post op I waiting for reimbursement check. The insurance wanted the full itemized bill and a whole bunch of extra stuff my doctor submitted 1000 times. Its always the insurance company more than the doctor that causes the issues. I hope everything works out!!

    • @leeheat333
      @leeheat333 2 ปีที่แล้ว

      @@kyyahabdularchives so I actually got my surgery approved and my doctor scheduled my surgery today! Exciting stuff, I'll prob make a video to talk about it but I'm curious to see how you're doing post op??

  • @jamesb9657
    @jamesb9657 2 ปีที่แล้ว +1

    I just started invisalign on the road to double jaw surgery

  • @jessicapershey1121
    @jessicapershey1121 2 ปีที่แล้ว +1

    Long post, so sorry, I just don’t know what to do anymore. So, I am on my second round of braces (due to teeth alignment, but also jaw locking and pain. Also, I did get a tooth implant done the year before braces came back on. This will come into play later). My orthodontist immediately on first appointment suggested naw survey due to my small mouth and teeth alignment. Since I am an adult, the expander would most likely not widen my upper mouth enough so surgery would give us the best shot at relief. She referred me to her go to oral surgeon, but I started with the expander just in case I didn’t want surgery. There was one right across her front door (literally two steps and you were in his office) so I got a consult there instead. Before doing so, I called my insurance and specifically asked about this oral surgeon and jaw surgery and was told he was in network and that is surgery is covered if it’s a developmental issue. So I did a consult and then a wisdom teeth removal. Now comes the part about insurance. Turns out, I now owed about $900 to this oral surgeon because he is not covered nor is anything to do with jaw surgery at all. I appealed due to misinformation and was declined because “we are not responsible for knowing the limitations or coverage of your insurance plan”. Needless to say I was pissed. Before the bills came in, I very much enjoyed the consult with this surgeon so I told my orthodontist to cut off the expander because we are going for the surgery. After changing jobs about a year later (for better insurance) I try out the original referralled oral surgeon. He says the exact same thing about what he wants with the double jaw surgery, and that I need it due to how my teeth are and how small my mouth is. Again, I didn’t call though but looked up my plan, and it said that he was covered and in network and that jaw surgery is covered for developmental issues. Due to medical and dental fighting over who covered what (also for double jaw surgery apparently they only covered half the face for one surgery. But would cover both sides of the face if I went back to surgery after 24 hours) it came out to the surgeons portion being about $20,000 that they wanted upfront, and to expect a couple thousand for the hospital stay as I would have to stay at least one night. I will say, after researching, I expected it to be $50,000 so I though this was somewhat achievable. Flash forward six months, my works insurance has decided to change their plans coverages. Guess what. Nothing is covered anymore. I now owe the surgeon $28,000 (they gave me a 30% discount) and am told to expect at least a $15,000 hospital bill. Also, as my appointments with the surgeon go on, I now need to most likely get my implant redone, along with veneers (I think that’s the word to make two teeth bigger since they are small). Also, after seeing this surgeon that my orthodontist referred me to, they finally talked to eat other after about six months. They orthodontist put power bands on and the surgeon asked me why since we want to space the teeth out. I always ask if they talked and they always said that they have opposite schedules. I’m tired of working towards this surgery. I’m burned out and not getting anywhere since life is happening. I am at a year and a half of trying to get the surgery but now few this much effort isn’t worth it. And I don’t want to take a loan out because we want to get out of being in an apartment. Plus we want to start a family soon. I just don’t know what to do. Starting at $43,000 is a TON of money.
    Edit: I have blue cross blue shield of Texas through work. I am wondering, does anyone have BCBS Texas just through the company and not work? If so, is it covered?

    • @kyyahabdularchives
      @kyyahabdularchives  2 ปีที่แล้ว

      I am so sorry you are going through all of this first of all! I actually plan on making an update to this video because I ended up coming out of pocket around $25,000 for my surgery. All my hospital bills were covered but the fee for the surgeon fell on me bc he was out of network. I think the next best step would be to press your surgeon to write a letter of medical necessity to the insurance company.

    • @jessicapershey1121
      @jessicapershey1121 2 ปีที่แล้ว +1

      @@kyyahabdularchives The first surgeon I went to do did that and was declined, and same with this one I’m trying to work as well. Well, his staff anyway, he always says “I don’t deal with the billing”. I asked the insurance lady from his office and she told me she wrote to them about the necessity of the surgery and was declined. I also asked about an exact number on the hospital bill and to make sure the anesthesia dr is in my network but they told me that They will not be able to get exact numbers until I schedule the surgery. Understandable. But your video was the first I have yet to come across about having insurance issues and I felt so very relieved that I was not the only one. Even googling, I only came across one or two, so I figured it’s not very common. My family tells me to get a second (but technically third opinion now) but I’m exhausted and tired paying money for something I “apparently” need. I say “apparently” because I know my teeth are set up for the surgery but I haven’t had pain for a while and am really on board to just keep the braces where they are at and not worry about this anymore. I know that cannot happen though😪 I look forward to your next post about your recovery and the financials. Thank you for letting us in on your jaw surgery journey.

    • @bels9773
      @bels9773 ปีที่แล้ว +1

      @@jessicapershey1121 Hi Jessica. I also have BCBS and need DJS😭😭 is your insurance specifically UT SELECT???

    • @absaultrevino
      @absaultrevino ปีที่แล้ว +1

      @@jessicapershey1121 what is the update as of today? I also have bcbs and dealing with something similar.

  • @Grace_Zandile97
    @Grace_Zandile97 2 ปีที่แล้ว +1

    Insurance stated its comestic surgery

  • @Momo-cv1oj
    @Momo-cv1oj ปีที่แล้ว +1

    In France double jaw surgery is zéro euro !!!’free !!!!for everybody in public hospital and in private 3000 euros

  • @laterrajackson73
    @laterrajackson73 2 ปีที่แล้ว +2

    How did you get Aetna to approve your surgery, what was the cause for you needing it , (if you dont mind me asking and you sharing)
    Also thank you for doing this video, it is one of the few videos that are helpful about such concerns and it is a big deal. Best wishes on your journey as well, as it is approaching February! ❤️

    • @kyyahabdularchives
      @kyyahabdularchives  2 ปีที่แล้ว +4

      Aetna approved it based on my difficulty chewing and the measurements my surgeon used from a tracing. Because my measurements were so off its medically classified as a “deformity.
      Thank you for watching! I wanted to seriously document everything about this journey because its more than just post op. The the nonsense before is alot! I have a new vlog coming where I talk about how im actually feeling mentally. I didnt think my underbite getting worse with my braces would affect me but it has. Yes im nearing the surgery date! Thank you for your support ❤️

  • @michaeldanzieri200
    @michaeldanzieri200 2 ปีที่แล้ว +2

    I have the same bite as you and I backed out of the surgery In august. My only concern for the future is if there is pain as you get older. Do you have pain now at 26. I am just 20 and feel fine

    • @kyyahabdularchives
      @kyyahabdularchives  2 ปีที่แล้ว +1

      Honestly, I think you should get the surgery and let me tell you why…
      When I was 16 they started to tell me I needed the procedure and my mom said “dont worry about it”. Typical for a foreigner to say bc in Nigeria they dont surgeries like this. However bc I didnt do it at 16 or 19 or even 22 when they told me AGIAN, my tmj worsened. When i got my wisdom teeth pulled out (because they were impacted) my 2nd molars on the top started hanging too low (they became erupted) the wisdom teeth were supporting those teeth and after they were pulled there was 0 support. So i had to get them pulled out because i couldnt bite down all the way. I cant keep my mouth wide open for extended periods of time bc it hurts my jaw. Both sides of my jaw click. I trip over my words alot and bite my cheeks. They told me i am at risk of developing sleep apnea without the surgery as I age…so surgery was the only option in my mind

  • @michaeldanzieri200
    @michaeldanzieri200 2 ปีที่แล้ว +2

    Do you have pain in your jaw ever that’s my only concern for the future. I’m only 20 and do not have pain I backed out of the surgery last august and don’t know if I should have went through with it

    • @kyyahabdularchives
      @kyyahabdularchives  2 ปีที่แล้ว

      Yeah I have bad tmj and I bit my cheeks alot which motivate me to eat less (not a good thing). May I ask what made you back out?

  • @Sunrise-fr9jb
    @Sunrise-fr9jb 7 หลายเดือนก่อน

    Who was ur surgeon?

  • @Mkmkmkmk545
    @Mkmkmkmk545 2 ปีที่แล้ว +1

    I’m so tired because I switch two insurance because they said they don’t cover and some dr said they don’t come in this network I’m looking since almost 2years I’m leaving in texas I don’t know exactly witch insurance will cover for my jaw surgery I’m so tired because of my breathing problem🥺

    • @kyyahabdularchives
      @kyyahabdularchives  2 ปีที่แล้ว

      I understand this on so many levels. Even with the pre-approval, the drama doesn't stop. I am still waiting for my check to come from the insurance company. I would recommend getting aetna or cigna. They both approved the surgery for me. Blue cross is ANNOYING and so is anthem and kaiser

    • @Mkmkmkmk545
      @Mkmkmkmk545 2 ปีที่แล้ว

      Thank you so much sister for giving me a information. And best of luck❤

  • @driedfred17
    @driedfred17 ปีที่แล้ว

    Hey is Kaiser that bad? I have Kaiser and I’m thinking of having surgery.

  • @tasnoor22
    @tasnoor22 ปีที่แล้ว

    ugh hopefully you see this im desperate 😫 i have aetna. How exactly did you have it approved? I love your results and im willing to fly out to the same surgeon that did yours.

  • @kyyahabdularchives
    @kyyahabdularchives  2 ปีที่แล้ว +2

    UPDATE: I HAD THE SURGERY th-cam.com/video/VyS1DnHHyYo/w-d-xo.html

  • @ubercomrade
    @ubercomrade 2 ปีที่แล้ว +2

    Dooooode we should chat. I live in Canada and want to chat the difference between our experience. Hit me up if you want to chat.

  • @zhere1364
    @zhere1364 2 ปีที่แล้ว +2

    You looksso beautiful!

  • @Commentcomment321
    @Commentcomment321 2 ปีที่แล้ว

    You are so beautiful now, you are going to be a complete knock out after ... good luck!

  • @MaxxMyLife
    @MaxxMyLife 2 ปีที่แล้ว

    Is this your health insurance or dental?

    • @kyyahabdularchives
      @kyyahabdularchives  2 ปีที่แล้ว

      health insurance. dental wont cover medical procedures

  • @nikkiyeahshedope9202
    @nikkiyeahshedope9202 2 ปีที่แล้ว

    Can I contact you , as far as atena did you use ppo & are you in nyc ?