Is Jaw Surgery Covered by Insurance?

Jaw surgery, medically known as orthognathic surgery, is a specialized procedure aimed at correcting irregularities in the jawbones. These irregularities can affect both the function and appearance of the jaw, leading to difficulties in chewing, speaking, breathing, and even in overall facial aesthetics. The surgery involves the repositioning of the jaws to achieve a more balanced and functional alignment, which can have profound effects on a patient’s quality of life.

Conditions treated by jaw surgery

Orthognathic surgery is typically recommended for adult patients with severe jaw discrepancies that cannot be corrected with orthodontics alone. In contrast to adults, pediatric jaws can be corrected if caught in time. This is the reason it is important for early orthodontic consults. When a jaw discrepancy exists in a pediatric patient, the orthodontist can utilize the child’s growth spurt to correct the discrepancy.

Conditions Treated By Jaw Surgery Include:

• Malocclusions: Severe misalignment of the teeth and jaws, such as underbites, overbites, and crossbites.
• Jaw asymmetry: A noticeable difference in the size or shape of the jaws, which can affect facial balance and symmetry.
• Sleep apnea: In some cases, obstructive sleep apnea can be caused by jaw positioning that leads to airway obstruction. Jaw surgery can help reposition the jaw to alleviate this condition.
• Temporomandibular joint (TMJ) disorders: Some cases of TMJ disorders, where the jaw joint causes pain and dysfunction, can be treated with jaw surgery.
• Facial trauma: Injuries to the jaw due to accidents or trauma may require surgical intervention to restore proper function and appearance.

Medical professionals involved in jaw surgery

Orthognathic surgery is a complex procedure that requires the expertise of several medical professionals. The surgery is primarily performed by an oral and maxillofacial surgeon, a specialist with extensive training in surgery of the mouth, jaws, and face. These surgeons are uniquely qualified to handle the intricate bone work involved in jaw surgery.

However, the process usually involves close collaboration with a dentist and an orthodontist. The dentist plays a crucial role in the initial diagnosis and referral for surgery. They may notice issues with bite alignment or jaw positioning during routine exams and suggest further evaluation by an orthodontist. The orthodontist will often prepare the teeth and jaws for surgery using braces or other orthodontic devices. This pre-surgical orthodontic treatment is essential to ensure that the teeth are properly aligned for the jaw repositioning, and to keep the teeth stable during the surgery.

Associated procedures and the surgical process

Jaw surgery is rarely a standalone procedure. It often involves additional treatments before and after the surgery to achieve optimal results.

Before the surgery, patients typically undergo orthodontic treatment to move the teeth into a new position that will work with the corrected jaw alignment. This phase can last anywhere from 12 to 18 months, depending on the severity of the case.

During the surgery, the oral and maxillofacial surgeon will make incisions inside the mouth to access the jawbones, thus avoiding visible scars. The bones are then cut, repositioned, and secured in their new position using plates, screws, or wires. The surgery may address one or both jaws, depending on the specific needs of the patient.

After the surgery, patients may need to continue with orthodontic treatment to fine-tune the alignment of the teeth. Additionally, patients may need to undergo physical therapy to regain full jaw function and movement. The recovery process can take several weeks, with most patients needing to follow a liquid or soft food diet initially to avoid placing stress on the healing jaw.

In some cases, dental implants may be recommended following orthognathic surgery. A dentist will need to evaluate the condition of the jawbone and overall oral health to determine whether dental implants are suitable, or if a dental bridge or dentures would be a better choice.

Aftercare and recovery following jaw surgery

Recovery from jaw surgery requires careful adherence to post-operative instructions to ensure proper healing. Patients are often prescribed pain medication and antibiotics to manage discomfort and prevent infection. Swelling and bruising are common in the initial days following the surgery, and patients are usually advised to apply ice packs to reduce swelling.

The diet during the first few weeks is critical, as the jaw needs time to heal without any pressure from chewing. A liquid or pureed diet is typically recommended, gradually transitioning to soft foods as healing progresses.

Oral hygiene is particularly important during this time. Since brushing might be challenging, patients are advised to rinse their mouth with a prescribed mouthwash to keep the area clean and free of bacteria. Regular follow-up appointments with the surgeon and orthodontist are necessary to monitor the healing process and make any needed adjustments to the orthodontic appliances.

What does jaw surgery cost?

Also, you should factor in the cost of orthodontic (braces) treatment as well, usually around $7,000 for an adult.

Insurance coverage for jaw surgery

One of the most significant concerns for patients considering corrective jaw surgery is whether the procedure will be covered by their insurance. The answer to this question can vary greatly depending on the specific circumstances of the surgery and the details of the insurance plan.

Medical necessity is the key factor that determines whether insurance will cover jaw surgery. If the surgery is deemed medically necessary—such as in cases where the patient has difficulty chewing, speaking, or breathing due to jaw misalignment—then insurance is more likely to cover the cost. This typically requires thorough documentation from the oral surgeon, orthodontist, and possibly other healthcare providers to demonstrate that corrective jaw surgery is essential for the patient’s health and well-being.

However, if the surgery is primarily for cosmetic reasons, such as improving facial appearance or symmetry without significant functional issues, insurance is less likely to cover the costs. Each insurance company has its own criteria for what constitutes a medically necessary procedure, so it is crucial for patients to consult with their insurance provider early in the process to understand their coverage.

Even if insurance does cover the surgery, there may be limitations. For example, insurance might cover the surgical procedure itself but not the orthodontic treatment that precedes and follows the surgery. This can leave patients responsible for a significant portion of the overall cost.

Exploring dental savings plans as an alternative

Given the potential for high out-of-pocket costs associated with jaw surgery, those who need this treatment might consider joining a dental savings plan. While jaw surgery itself may not be discounted, dental savings plans offer reduced rates on a wide range of dental services, including orthodontic treatment, which is often necessary before and after corrective jaw surgery.

Unlike traditional insurance, dental savings plans don’t have annual spending limits or restrictions on when and how often you can get dental care. Dental insurance typically has an annual maximum of $1,000-$1,500 and often does not cover orthodontics treatment for adults.

Dental savings plan members report saving around 50%* on the cost of their dental care.

There is a dental plan to fit every dental care need and budget. The quickest way to find one that can help reduce the costs associated with jaw surgery is to compare plans on DentalPlans.com – with over 25 dental savings plans and dental insurance plans, you can find a plan that fits your needs all in one place.

Summing it up: jaw surgery and insurance

While orthognathic surgery can be a life-changing procedure for those with significant jaw issues, it comes with a complex and potentially expensive treatment plan. Understanding the roles of the medical professionals involved, the surgery and recovery process, and the intricacies of insurance coverage can help patients navigate their treatment journey more effectively. Additionally, exploring alternatives like dental savings plans can provide financial relief for portions of jaw surgery treatment, making this essential procedure more accessible. If your insurance doesn’t fully cover the cost, exploring dental savings plans can offer significant discounts and help make jaw surgery more affordable. Always consult with your medical team and insurance provider to understand your coverage and explore all available options for managing the costs associated with jaw surgery and related dental procedures.

All cost averages obtained from the DentalPlans.com procedure search tool, and independent research.

*Discount health program consumer and provider surveys indicate average savings of 50%. savings may vary by provider, location, and plan.