Insurance appeal denied jaw surgery for the second time (AFTER I WAS ALREADY APPROVED 9 MONTHS AGO and surgery is in a month…)

Hi everyone,

I'm not in a great place right now and just wanted to get some advice and see if anybody has had a similar experience. I'm in Michigan with Priority Health insurance.

9 months ago, I saw an orthodontist, who referred me to an oral surgeon, and I was approved for both upper and lower jaw surgery by Priority Health.

This approval allowed me to start braces (Ortho wanted to wait for the jaw surgery insurance approval before starting treatment), and everything seemed to go smoothly. I even have a surgery date scheduled in a month.

However, we've just found out 2 weeks ago that Priority Health is now denying my coverage, even though it was initially approved. My surgeon has already filed two appeals, both of which were denied. For the initial appeal, they wanted proof that I've been on Orthodontics for 6 months, which I have. Still denied. For the second appeal I've just heard from my surgery scheduler that "Priority Health is not sure why it was approved in the first place".

This is incredibly confusing and puts me in a very bad financial spot. I've already had to shell out 7k for the braces (that wouldn't have been covered anyways), but I was on the understanding that the surgery itself would be covered.

How can the insurance approve me, start me on this journey, which led me to get braces for 9 months, then deny me a month before the surgery? It seems completely predatory.

My surgeon is working on a third appeal and I've contact my dentist and SLP as well, as well as getting a sleep study done. What if I "pass" the sleep study? I know I have a rough time sleeping, wake up tired, and have a family history of severe sleep apnea, but at this point the sleep study seems like my only way to coverage.

I'm just at a low point now and wanted to vent, get some info, maybe hear some similar stories or anybody that has experience with Priority Health. Thank you

submitted by /u/ineedironwood
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