Sharing my story in case helpful.
I have Blue Cross Blue Shield, Federal Employee Program and am enrolled in the “basic” plan. My surgeon originally filed the pre-authorization before surgery (for Lefort I and BSSO), and BCBS denied pre-authorization because “genioplasty was for aesthetic purposes only”. We weren’t even asking for genio coverage(and I’m not even having it done).
Surgeon filed for an expedited appeal, which BCBS declined. My surgeon then filed a formal (non-expedited) appeal on March 25th, and I just found out this week that BCBS approved both Lefort I and BSSO (although I’ve decided to do Lefort I only on my surgeon’s recommendation).
In terms of movement, I have a class III bite (underbite) and slight cross bite. We are going to advance my maxilla 5 mm forward and do a little rotation to align with my mandible which is staying in place. Surgery will happen in a few weeks. In terms of jaw issues, I literally can’t bite or chew anything without my bite turbos, and I have a lot of pain and wear where my teeth do actually touch when I don’t have the bite turbos on.
I was really worried my insurance would deny coverage in response to the formal appeal, but I’m so relieved to share that it got approved. Happy to answer any questions. I didn’t find a lot of information on this sub about the BCBS FEP coverage when I was in the middle of the appeals process, so I wanted to share.
ETA: Not sure if it’s relevant, but surgery is happening in Massachusetts.