Around this time next year I will need to have a medically necessary jaw surgery after being in braces for a year. In our summary plan description, it states that reconstructive jaw/orthographic surgery is covered under our policy if the operation is done to correct TMJ, treat sleep apnea, restore proper function after an illness or injury, to correct a congenital anomaly, or to correct developmental anomalies. I fall in to the developmental anomaly category.
At the same time, there’s a section that states that cosmetic/reconstructive surgery, services and supplies even if medically necessary are not covered unless it’s to correct a congenital anomaly, to restore a physical bodily function lost as a result of an illness or injury, or breast reconstruction after a medically necessary mastectomy.
Which takes precedence? The part that says orthographic surgery is covered for developmental anomalies or the part the says all cosmetic/reconstructive surgeries are not covered unless it’s to correct congenial anomalies, after illness or injury or breast reconstruction after a medically necessary mastectomy.
My doctor won’t submit a prior authorization request until august so I won’t know if this is covered until then.
submitted by /u/GhostRunner24
[link] [comments]Around this time next year I will need to have a medically necessary jaw surgery after being in braces for a year. In our summary plan description, it states that reconstructive jaw/orthographic surgery is covered under our policy if the operation is done to correct TMJ, treat sleep apnea, restore proper function after an illness or injury, to correct a congenital anomaly, or to correct developmental anomalies. I fall in to the developmental anomaly category. At the same time, there’s a section that states that cosmetic/reconstructive surgery, services and supplies even if medically necessary are not covered unless it’s to correct a congenital anomaly, to restore a physical bodily function lost as a result of an illness or injury, or breast reconstruction after a medically necessary mastectomy. Which takes precedence? The part that says orthographic surgery is covered for developmental anomalies or the part the says all cosmetic/reconstructive surgeries are not covered unless it’s to correct congenial anomalies, after illness or injury or breast reconstruction after a medically necessary mastectomy. My doctor won’t submit a prior authorization request until august so I won’t know if this is covered until then. submitted by /u/GhostRunner24 [link] [comments]Read Morer/HealthInsurance