Brandy's Braces, SARPE, Jaw Surgery Journal

This is my daily journal to my eventual perfect smile and Apnea free life. It logs my surgeries, and daily progress.

Friday, March 09, 2007

Insurance Stress may kill me before Apnea does!

I'm trying to stay calm about all of this insurance stuff. I started as early as I could with it, getting the initial pre-auth before I ever even got the orthodontics. I mean I wasn't going to do all of this if it wasn't covered. So...we had the SARPE, got the braces, now I'm ready for surgery.

My treatment pan changed though, so now I'm having to go through the whole pre-auth stuff all over again, with the new treatment plan information. I'm now looking at upper jaw and genio in addition to the original lower advancement. My insurance lady told me that it should be fine, that treatment plans change all the time. That the doctors just don't know for sure how things are going to work out until they get in there and start moving everything around. So, I ended up paying $7200.00 for my braces and another $1,000 for my SARPE.

The other day I get a copy of an email from my insurance lady. It was the info she sent to the main lady at the insurance company. She had emailed her back saying

"This will still be okay as is, but no orthodontia is allowed under the Plan."

So I'm like all happy, and proceed in doing all the stuff in the post below. Today my insurance lady emails me again. She talked to them about the info the doctor needs etc and emails me saying "FYI, that it looks like we should be getting something in writing soon." An again she forwards me the reply from the lady. Only today, I'm sortof freaking out about what the other lady wrote. She said:

I have done a revised pre-treatment estimate that will go out tomorrow, or the info should be on the website currently. The charges submitted will be allowed, but 2 of them will be reduced as multiple procedures and then there is always the chance that HCI may edit for unbundling. I would like to talk to you a bit more about this one and a couple other things that I still have out there for you.

I of couse emailed her back, asking her if I should be freaking out now, or just wait til the pre-treatment estimate comes. I told her that I was under the premise that this was all going to be covered and that as it is, my doctor wants me to put like 10,000 down. I can't afford to go $20,000 into debt to do this, I would've never started it if I had known in advance that this would not be covered 100%. I'm waiting to hear back from her, or maybe I should say that I'm sick to my stomach waiting to hear back from her. What does this all mean? Why would the amounts be reduced for "multiple procedures?" Who, or what is HCI? I'm really stressed out about this! I mean I HAVE to have my surgery in May, if I miss this summer window I can't do anything until next May again?! It would totally suck! Now I know I still have over 2 months to get this worked out, but right now.....that feels like it is coming up really quickly! CALGON....TAKE ME AWAY!!!!!


  • At 5:59 AM, Blogger Mary said…

    Hey Brandy, Sorry to hear about your insurance woes. Does your company have a benefits person? If so, can you ask that person to run interference on your behalf. You are entitled to exactly what is stated on your policy or what has been represented to you and what you have relied upon. My benefits director actually hired an outside company to deal with all the insurance issues--maybe something like that is available. The last thing you need pre-surgery is all this stress. Good luck. Mary
    PS--Hope you have a fabulous birthday.
    PSS--I felt an acupuncture needle in my chin last Thursday!!


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