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.

Saturday, April 07, 2007

Insurance Aggravation! Why Do they Make Things So Difficult???"

My insurance lady emailed me back today. Seems the insurance company doesn't think my genioplasty is "medically necessary" This is what they said.

"Based on what has been provided, this is not considered to be medically necessary. If the provider can give us something more to substantiate how this will help treat sleep apnea, we can review again."

So I said:

"I guess I'm confused as to what he would need to provide. It states right in the medical neccessity letter that it is medically neccessary to move the hyoid bone forward which has been shown in the research, when done in conjunction with Upper and lower surgery to increase the airway.

This quote was taken right of of a website I found:


An operation performed to reshape the chin. Genioplasties are often done to treat OSA because the procedure changes the structure of the patient's upper airway.

When MMA is done the surgery usually takes 3 main forms done together. It's referenced on this Mayo Clinic website.

What else would he need to include?"

This is what she said back to me:

"They are probably looking for proven statistical medical efficacies that would substantiate the claim. You provider should be able to easily provide this information."

So now on Monday I need to call my doctor and ask him if he can provide documented proof that sliding genioplasty is actually beneficial and does in fact help with correction of sleep apnea. EVEN though, I can find info about it all over the web. How messed up is that? Guess....the fight is on! :(


  • At 7:08 AM, Blogger Graham said…

    What a bunch of BS! Fight is right, good luck!

  • At 8:04 AM, Blogger 57rdi said…

    Hello, and thanks for the positive thoughts in the post to my blog.

    My insurance company's (BCBS) first pass at GA was to deny it as well. But they turned around and approved it with no fuss after my doctor appealed. I'll bet the same happens with yours. Of course, as they say in the approval letters, they aren't actually guaranteeing that they'll pay or anything. ...

    In any case, I wouldn't sweat this one. I'll bet it turns out fine.

    As for me, I'm counting the minutes now until Tuesday, wavering between excitement and dread. I'm trying to do all I can to stay on the excitement side of things.

    Good luck to you!

  • At 8:24 AM, Blogger Mary said…

    It is BS, I have never heard of a doctor having to prove that something is not only medically necessary but also prove it statistically. Can you say "bad faith!" Clearly they want to discourage and defeat you so that you give up and then they don't have to pay. That is the way of insurance companies. So like Graham said, just keep up the good fight! And boy, you sure do know how to do your homework! M

  • At 9:01 AM, Blogger Bill said…

    Keep at it Brandy. It'll be very hard for the insurance company to deny the request because of "lack of statistics" ... especially now that the Surgeon's office has provided documentation stating it's a medical necessity due to Sleep Apnea.

    There has to be plenty of corroborating medical information readily available to the insurance company. Sounds like they're just pushing to see if you'll abandon your request.

    Like others have said ... keep fighting!

  • At 4:58 PM, Blogger 57rdi said…

    Brandy, I'd respond to your last message, but I'm not sure where to do it. I can respond to your questions, but maybe by e-mail? Posts to my blog don't publish auto-magically like yours. Otherwise, I'd give you an e-mail address here. So if you want me to respond, send an e-mail address by posting to mine. In any case, the info about how far they're moving me is in my first post -- a total of 12 mm.

    And, yes, I'm about as tense as you are. But, I wouldn't change anything or give up this chance for anything. As my friend Bill McIlwain says: Onward!


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