MMA surgery exclusions - urgent !
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MMA surgery exclusions - urgent !

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Posted by jay on February 20, 2008 at 11:19:14:

Hi all - I'm scheduled for an MMA with Dr. L next week. I have premera blue
cross insurance and they do not require pre-authorization for surgery. They
also have orthognatic surgery (any procedure to shorten or lengthen the jaw)
listed as an excluded surgery - regardless of the underlying condition.
(otherwise sleep apnea procedures appear to be covered). with plans like
mine that do not require pre-auth, the only way to appeal then is to have
the procedure and then submit the claim. then its denied and then you can go
thru the appeals process.

that is what i'm strongly considering doing. BUT...i'm looking at a six
figure hospital + surgery fee for this operation! and concerned about
whether i will be able to win an appeal.

I spoke with Bill and Lisa who were very supportive and told me of their
eventual success battling the insurance companies.

I'm looking for advice from those of you who have already HAD this procedure
done. Have any of you been in the same situation? were you able to appeal
successfully? has anyone had an MMA that was excluded by their policy and
then been stuck with a 6 figure bill? (Fully excluded by their policy,
etc.).

thanks!

jay

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Subject : Re: MMA surgery exclusions - urgent !

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PLEASE ONLY CLICK THE SUBMIT FOLLOW UP BUTTON ONCE!!. Thanks, Sandman

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