Re: Deep Overbite does not necessarily need correcting .......

From: The Webby (nospamattmjiatroepidemicnospam_at_san.rr.com)
Date: 09/08/04 

Date: Wed, 08 Sep 2004 15:43:44 GMT

On the portion about justification of the procedure, here's what
happened in my case:

The maxillofacial surgeon submitted a request to my insurance company
for "preauthorization". That doesn't/didn't mean they would cover all
costs but rather, it means that the patient can be admitted to the
hospital for the procedure based upon medical necessity.

The surgeon *told* me that the procedure could only be done on an
asymptomatic patient. ... That once the patients had symptoms of pain,
the procedure would not help the joints. And so time was of the
essence. We had to get the ortho done and the surgery done *before* I
had any problems at all. ... So that was my understanding.

It was not until after the surgery was done and until I requested and
received my records from him so that I could go to another surgeon, that
I saw a copy of the letter he had submitted to the insurance company.
There it was in black and white ... a completely different me. He
requested they cover the procedure ***because*** the patient had a
history of severe TMJ pain and dysfunction. And that was why he asked
them to preauthorize.

Why did he falsely describe the patient? The insurance company
testified that they would never have preauthorized the procedure on an
asymtomatic patient. Testimony went on to say that the surgeon must
have known that he could not make a request for orthognathic surgery on
me as I was.

Back in the early 1980s, people were not allowed to see these letters
sent to insurance companies. It was a secretive time. Patients could
barely get a copy of their own medical records.

Anyway, the History and Physical that was a part of my medical record
was completely inaccurate. I went to see surgeons after the surgery no
knowing that they were thinking that I had a ***history*** of TMJ pain
and dysfunction before the surgery. They just figured that the problem
was an old problem and orthognathic surgery wasn't going to solve it
anyway.

....as it is said, oh what a mighty web we weave when first we set out
to deceive. I was surely deceived at every possible point on the map.

Thanks for your explanation and info. I'm sorry to have gone on a
tangent about my own experience but it seemed to be the correct timing.
I'll add comment on your post separately from this.

TW

In article <1gjroky.1o455h11eeni1rN%stovepipeTR@SHglobetrotter.net>,
 stovepipeTR@SHglobetrotter.net (StovePipe) wrote:

> The Webby <nospamattmjiatroepidemicnospam@san.rr.com> wrote:
>
> > SP, in this story, the patient wanted maxilla relocated for aesthetic
> > reasons. Does you welfare system pay for elective aesthetic
> > surgeries??? I am having trouble understanding how the woman was so
> > efficient in obtaining cosmetic surgical care from an ENT, but the same
> > woman was unable to receive endodontic care because it isn't
> > covered??????? What am I missing here????
> >
> > Before I go any further, I must learn how this could be so.
> >
> > TW
>
> The surgical procedure as performed by the ENT was justified as a
> medical necessity (I honestly don't know on what grounds, but it
> wouldn't be hard for him to advance prevention of further damage as the
> main reason).
>
> MEDICAL procedures are coverd, but must be *justified*, and of course,
> there is a waiting list.
>
> DENTAL procedures (in limited fashon) are covered for young children
> (under 10yrs) and for the welfare cases. You get basic fillings (white
> in front, Amalgam in back), root canals (ONLY on kids under 10yrs),
> plastic removable dentures only, Exam/cleaning once a year, and that's
> about IT. No fixed prosthesis (Crowns/Bridges)...
>
> I don't 'think' the procedure would have been totally covered under the
> Maxillofacial Surgery side UNLESS there were some easily demonstrable
> anomaly or hazard accepted by the governmental evaluating body. This
> means that if the procedure was simply ESTHETIC in nature, she'd have
> had to pay for it. Judging by the size of the office that the Maxillo's
> have at the local hospital, I don't *think* they have too much trouble
> finding reasons to perform their surgeries, either.
>
> So, as you can see, it would seem that the MD's and the Oral Surgeons
> get a better deal from the gov't than the dentists do (root canals are
> NEVER permitted past 10 years old, etc).
>
> I can also tell you that the $$$ we get for working on welfare cases is
> laughable, and hasn't been augmented since the late '80's.
>
> Hope this sheds more light on your question.
> SP

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