Because of its hybrid character, Medicaid is most likely to cover corrective jaw surgery. Medicaid is largely a health insurance program, however it does cover dental work for adults on occasion.
The federal government establishes the framework, but it is up to the states to decide who is eligible and what benefits they will provide. This debate should include two state-level Medicaid considerations.
- Most states cover children under the age of 21 who meet the 26-point standard for a malocclusion.
- Unless they live in Oregon or Washington, DC, those over the age of 21 must have a medically necessary cause.
Medical
Obtaining health insurance coverage for corrective jaw surgery necessitates demonstrating that the procedure is medically necessary: the service addresses an ailment, injury, condition, disease, or symptom.
Plastic surgery is used to fix portions of the body that are malfunctioning, and it is frequently medically required. Cosmetic operations, on the other hand, improve appearance by improving aesthetic appeal, symmetry, and proportion, but they never meet the standards.
Plastic
Orthognathic operations that come under the heading of plastic surgery are more likely to be covered by health insurance. Some situations are a slam dunk, while others require your practice to submit a written narrative documenting less intrusive treatments that have been done as well as why the reconstructive procedure is your sole option for a resolution.
Plastic surgery, including these jaw operations, is frequently covered by insurance since it reconstructs face and bodily flaws caused by congenital deformities, accidents, or illnesses.
- A broken or dislocated jaw caused by direct force trauma to the face requires open reduction.
- Cysts and malignant tumors are removed from the mandibulum before they metastasis and spread to other regions of the body.
- Correction of major congenital malformations like a cleft palate, micrognathia (small mandible), or agnathia (absence of the condyloid process)
- Osteonecrosis of the jaw (ONJ) is a condition in which dead (necrotic) bone is exposed in the mouth and must be removed.
- Pain and dysfunction caused by Temporomandibular Joint Disorders (TMJ or TMD) or arthritis can be treated with surgical joint operations.
- Surgical procedures to treat obstructive sleep apnea, a condition that can cause high blood pressure, headaches, stroke, and heart failure.
Cosmetic
Cosmetic jaw surgery charges are never covered by health insurance because they are not medically required. Taking out a loan to assist pay for cosmetic procedures that do not address an underlying disease, injury, or defective bodily component is one option.
Cosmetic surgery, including these jaw operations, reshapes healthy tissue to improve beauty and symmetry, therefore insurance companies deny claims.
Is jaw realignment surgery covered by insurance?
Orthognathic surgery (jaw straightening) is not covered by dental insurance, however it may be covered by medical insurance. Although some medical plans specifically ban orthognathic surgery, most insurance policies allow orthognathic surgery to be authorized “when medically necessary.”
How do I know if my insurance covers jaw surgery?
If a functional problem can be demonstrated, orthognathic surgery is generally reimbursed by insurance, presuming your insurance plan does not have any exclusions for jaw surgery.
The cost of jaw surgery varies depending on the surgeon’s skill, the treatment performed, and the location of the clinic. To help pay costs, many cosmetic surgeons offer patient financing schemes, so be sure to inquire.
Is corrective jaw surgery considered cosmetic?
Unfortunately, many people mistakenly believe that corrective jaw surgery is merely a cosmetic operation. Many health insurance policies, however, cover orthognathic (jaw) surgery, and obtaining insurance coverage for jaw surgery is easier than many individuals believe. Dr. Grant McGann, an oral and maxillofacial surgeon in San Diego, works hard at McGann Facial Design to ensure that his patients’ insurance coverage pay their jaw surgery charges. Most health insurance policies, such as those offered by Aetna, Anthem, and other companies, have appropriate jaw surgery coverage guidelines.
Dr. McGann’s insurance specialist, Enrique Cardenas, works with patients to have their operations covered. Enrique and the rest of the team at McGann Facial Design work hard to become familiar with each insurance company’s coverage requirements, and can even advise patients who have not yet obtained insurance or are considering changing policies on which companies and plans will provide the best jaw surgery medical coverage.
Many people wonder if jaw surgery is aesthetic, but just because something improves someone’s appearance doesn’t mean it’s required or desirable. An underbite, overbite, or asymmetry of the face
It can cause physical pain, inability to eat, or even more serious disorders like sleep apnea, in addition to making someone feel self-conscious about their appearance. Medical insurance companies are well aware of this, and it is in their best interests to treat jaw surgery patients before their problems escalate into more costly medical and dental issues later in life.
“Thinking about jaw surgery as a medically essential treatment rather than a cosmetic procedure is much more reasonable,” adds Enrique. “At least, that’s how insurance companies perceive it, and it’s also how we view it.”
How do you get approved for jaw surgery?
The following are some examples of situations that necessitate corrective jaw surgery:
- You’ve had a face injury or have birth abnormalities that have caused your jaw to misalign.
How much does it cost for underbite jaw surgery?
Jaw surgery to repair an underbite might cost anywhere from $20,000 to $40,000 without insurance. When only one jaw requires surgery, the costs are usually lower. An examination, X-rays, general anesthesia, bone cutting, bone contouring, and jaw relocation are all part of the procedure.
Is malocclusion covered by insurance?
2. Minor malocclusion adjustments are considered cosmetic. NOTE: A group can specify which dental services are covered under their dental or medical plan, as well as which services are subject to dollar constraints or other limitations.
Will Tricare cover jaw surgery?
Treatment for Temporomandibular Joint (TMJ) Syndrome may be covered by TRICARE. Acute myofacial pain dysfunction syndrome is another name for this condition.
Your treatment must focus on a medical issue rather than a dental one. Only when it entails urgent pain relief is it considered a medical issue.
Within a six-month period, you may receive more than four visits.
However, your supplier must properly document this.
What does a genioplasty do?
Genioplasty is a type of chin cosmetic surgery. Genioplasty can be performed by both plastic and maxillofacial surgeons.
Sliding genioplasty and implant augmentation are the two forms of genioplasty treatments.
The treatment to utilize is determined by a number of criteria, including the amount of chin augmentation required, the surgeon’s expertise and experience, and personal preferences.
People who are self-conscious about the appearance of their chin may benefit from genioplasty.
The surgery can improve the overall appearance of the face by adjusting the chin’s location and size to better match other facial characteristics including the forehead, cheeks, and nose.
Is jaw surgery medically necessary?
When intended to change a physical look that would be deemed within normal human anatomic variation, mandibular/maxillary (orthognathic) surgery is considered aesthetic and not medically required.
Is corrective jaw surgery worth it?
Jaw surgery can be intimidating, terrifying, or both. It’s difficult to accept that your jaw has to be straightened. Finally, the years of having a symmetric, physically pleasing jawline are well worth conquering the surgical components of orthognathic surgery.