Is facial reanimation considered medically necessary?

[lorigasper]

Greetings, all!

I'm just beginning to look into facial reanimation options and I'm wondering how surgery is approached with insurance.  My insurance doesn't cover anything cosmetic.  Any suggestions?  I'd love to think that I'd be able to make speech sounds correctly (I'm a teacher!) and drink my coffee with no dribbles, you know?

Thx!

[cassie]

Hello. I am at that point too, and I keep getting rejected for everything from my insurance company. I'd like to know from others, if you have had sucess with getting facial reanimation covered, and if so, how did you do it? It's frustration to be stuck here, one year post-op, with a still mostly- not- moving face! What type of doctor would actually do the facial reanimation?

Cassie

[lorigasper]

Good morning, Cassie -
I had a helpful conversation with a nurse yesterday that works for my insurance company.  To start, he's having my surgical records sent for their review and he's asked my to be evaluated by a plastic surgeon who does reconstruction work as part of his practice.  They, of course, are looking for what is "medically necessary" to "restore function."  I'll keep you posted.....
Lori

[Kathleen_Mc]

Here in Ontario all that I had done was covered and not seen as "cosmetic" so it was all covered by OHIP. I understand things would be different in the US

[lorigasper]

Hi Cassie -

Here's my update.....I'm scheduled for a 12/7 transfer in mid-December.  No difficulties from my insurance.  My doctor said that they know what codes to use, and it was approved.  If your surgeon needs someone to walk him through the process of submitting your surgery for approval, I'm sure may doctors who do this surgery could help.  My doc is Dr. Hegarty in Colorado Springs.  Hope that helps.  I wish you well.  Please let me know if there's anything else I can offer.

Lori

[Smedina]

Lori,

Good luck with the surgery! I had mine done in 2012 (no insurance issues). It's a slow healing process, so being patient helps. A lot. Glad to share my experience as you go through the preciousl process.