Jaw surgery, also known as orthognathic surgery, is a medical procedure used to correct conditions affecting the jaw and face. The surgery can range from simple procedures that target specific areas of the mouth to complex surgeries that require weeks of recovery time.
Due to the cost of these surgeries, many people wonder if insurance covers them. Here, we will explore whether insurance covers jaw surgery and what factors affect coverage.
What Is Jaw Surgery?
Jaw surgery is performed by an oral surgeon or maxillofacial surgeon and lifts or reconstructs your facial bones in order to align jaws and teeth for better bite function. It may be necessary when your teeth don’t meet correctly when you bite or if one jaw grows too far forward or backward in relation to other facial features such as nose position. These conditions — often referred as malocclusions — help identify children with early problems who are starting down the path of developing malocclusion rather than allowing them to develop adult-type dental misalignments.
There are several types of jaw surgery:
- Orthodontic-related: Procedures aim at correcting issues typically requiring braces first.
- Maxillofacial-related: Procedures use biocompatible plates/screws/titanium screws/thin hypotube devices made with advanced CAD/CAM technologies for bone treatment.
- Trauma-related: Required after injury when needed.
What Causes a Need for Jaw Surgery?
Many situations might trigger a necessity for jaw reconstruction including diseases interrupting bone growth like cancerous tumours on head or neck region & infection; congenital abnormalities which cause underdevelopment/overgrowth/poorly formed facial structures; projections dwarfism/facial trauma/accidents/degenerative joint diseases which lead to erosion/destruction/wear-&-tear changes on bones within TM Joints could necessitate some form correction through surgical interventions by a maxillofacial surgeon.
Reasons for Having Jaw Surgery
There are several reasons a person may need jaw surgery. Some of the most common reasons include:
- Difficulty chewing or biting food
- Speech problems
- Sleep apnea
- Pain or discomfort in the jaw joint
- Open bite
Does Insurance Cover Jaw Surgery?
Whether insurance covers jaw surgery largely depends on two main factors: the reason for the surgery and the type of insurance plan you have. The coverage will vary according to each individual’s situation, case history, test records, employment status and insurer policy.
Reason for Surgery
The most critical factor that determines whether insurance covers jaw surgery is why an individual needs it. If someone requires surgery because their jaw condition negatively affects their health or ability to function correctly, it usually falls under medically necessary treatment.
On the other hand, if somebody wants cosmetic changes made to their face without underlying medical issues being rectified as such like rhinoplasty. . . . then this falls under elective/cosmetic procedures which insurances do not cover.
Hence, people who choose surgical procedures benefit themselves without any indication of major approved medical problem requirement alike those required by third-party insurers.
Type of Insurance Plan
Another factor that influences whether an insurance company will cover an orthognathic procedure is what kind of plan you have. There are generally four types:
- HMO: This type has limited network access options & out-of-network benefits require referrals from licensed physicians beforehand – normally few reimbursements could be done! Thus patients come with very high deductibles & higher co-pays compared to others cuz these policies have comparatively cheaper premiums than traditional plans.
- PPO: This type of plan involves fewer restrictions, but out-of-network services will cost more.
- EPO: These require patients to pay for everything unless there’s emergency care.
- HDHP:These come with lower premiums compared to PPO/HMO plans but have higher deductibles reaching up to $5000/life. They will only cover costs once the deductible balance are paid off.
How much does Jaw Surgery Cost?
Jaw surgeries can vary widely in cost depending on a multitude of factors such as disease severity, surgeon`s speciality/credentials/experience/location/facilities, surgical requirements , post-surgical therapy sessions required & health insurance policies that you have subscribed for yourself!
For those whose policy covers surgery such as these & has also confirmed by referring Doctors that their orthognathic surgical procedure is necessary and not elective ; they might benefit from significant discounts ranging from 15% to 75%, which varies based on the insurer’s limits/caps of coverage each patient signed up earlier while subcribing the insurance policy.
However; it’s estimated that a complete jaw surgery may cost anywhere between 20k$-100k$ depending on how complex or simple your case may be!
In conclusion, whether insurance covers jaw surgery depends largely on two factors: why someone needs it and what kind of insurance plan they have. If you suffer from medical conditions that necessitates orthognathic procedures, check with an oral surgeon or maxillofacial specialist alongside understanding your insurances/policies before undergoing any complex surgical interventions! Surgically correct malocclusions/dental abnormalities/hard-to-treat problems may help improve speech intimacy and breathing patterns thereby enabling better nutrition/positive outcomes providing happy smiles too!