Jaw Surgery / Health Insurance / Financial Advice Needed Please

glub on 21/09/2020 - 10:03
Last edited 21/09/2020 - 10:25 by 1 other user

I currently am only on Medicare and am actually on a waiting list for rhinoplasty (my body hates me), I was told if I got health insurance it may mean this surgery is no longer covered, which I am not sure is the case, but I didn't want to risk it as I have been on the waiting list for a year.

However, I have been having discussions with oral surgeons and orthodontists to treat a pretty severe open bite, I have been advised multiple different treatments from different surgeons
- SARME and skeletal anchorage plates only / SARME followed by a bimaxillary osteotomy (double jaw surgery) and a genioplasty
- I also need my wisdom teeth removed
- I will then need braces to straighten the teeth

I think I am leaning towards having it all done, as I want to ensure it's going to give me the best possible results and I will never need surgery again I hope.

The financial cost of this is going to be ridiculous, I am 25 have a pretty decent job, but spending around $30k on this when I am so young is a daunting and depressing thought.

I am looking at health insurance, but as I am not yet on a permanent visa I only qualify for Overseas health cover, which complicates things even further. I am originally from the UK but here on a 5-year visa.

I tried to get some quotes from the insurance guys and discuss what would actually be covered, no one can really give me a straight answer, the last health company I spoke to stated "all hospital bills which would be covered by Medicare would be covered", however, I was unable to find out anywhere what Medicare would even cover out of the above, I know for sure I would only get around $1k for braces refunded, which is less than the cost of the insurance!

I've also considered flying to Thailand or some Asian country and getting the treatment done, but I am worried if there was any ongoing treatment required what would actually be covered.

Finally, I guess another option is to try and go through the NHS in the UK and see if I could get it covered there, which would mean I would have to return home for a month or so, which would be fine, but I don't know how long the waitlists are there I also plan on residing here for the foreseeable future, so ongoing treatment may be complicated.

I am just looking for any advice I can receive on people who have gone through similar and what would be my best options financially and health-wise, this is all very overwhelming and I don't really know where to source any of this information

Health & Beauty

Comments

  • Crosscade on 21/09/2020 - 10:44
    +4

    I won't want to scare you off of surgery if you really needed it, but I had lower jaw surgery to correct an underbite about 12 years ago and pretty much now have constant dull pain in my jaw since. Not enough pain to be on painkillers all the time, but something I feel does contribute at times to headaches.

    If I could go back and just have orthodontics only and leave my jaw I probably would.

    • glub on 21/09/2020 - 14:54

      The orthodontist basically told me braces alone is not an option and without surgery is likely to just get worse again in a few years, I guess there is always these risks associated with big surgeries.

      I've already actually had braces when I was 16 for 4 years, I literally hated them and because of my open bite and the issues with my tongue because of this all of my teeth have just shifted out of place again so as much as I wish I could I just don't think it would be viable.

  • YadaYadaYada on 21/09/2020 - 10:47

    The other tricky thing now is that if you wanted to try any of the overseas options, you'd have to apply to be let back into the country, since you aren't a citizen. Plus the flights aren't particularly cheap nowadays, with limited numbers allowed each week, on top of the quarantine costs that you'd have to potentially pay here on return (3K in NSW).

    Orthodontics to straighten teeth is also an ongoing process, so not sure how you'd be able to just get that done overseas without staying for a decent time.

    Private health insurance doesn't replace Medicare - it supplements it. If you go via the public system (Medicare), waiting lists are generally longer than going via private health insurance, but the insurance costs you money vs Medicare which is free. Private health insurance also has typically waiting periods (which are sometimes waived on joining), and depending on what you want done, you'll have to wait a certain period before you can claim.

    • glub on 21/09/2020 - 14:55

      If I was going to go with the overseas option its likely I would just wait a year or so until things hopefully sort themselves out. I'm in no major rush aside from just wanting it over with, but also happy to balance this out with financial impact.

      Orthodontist I would get here due to the ongoing visits etc.

  • Drakesy on 21/09/2020 - 11:59

    If you want to dodge the big out of pocket expense it looks like taking out Private health and seeing out the 12 month waiting period might be the best way around this. Personally i've had a rhinoplasty surgery and it was good (i think the whole procedure was $4,000 minus $3,000 which was covered by private health so out of pocket $1k. The jaw may be another story.

    It just depends how much you value a change in your lifestyle.

    • glub on 21/09/2020 - 14:57

      Damn, that's pretty good, when I was originally quoted for my Rhinoplasty surgery they said it would be 12-14 but covered by medicare which is why I never went with health insurance as this seemed like the best option! But I have been on a waiting list over a year am completely in the dark as to when its likely to happen and don't really get any updates, so looking back maybe I would have looked at health insurance earlier.

  • screensaver on 21/09/2020 - 12:24

    Do you have to get this mouth stuff done, it is major surgery

  • [Deactivated] on 21/09/2020 - 12:57

    You are getting a forum full of all sorts of people to critique the treatment options provided to you by someone with a medical and dental degree, and further speciality studies, with the aid of cone beam radiographs and physical study models…

    Even with my educated guess, I can safely tell you that I can't tell you jack. You have about 25 years of relevant academic achievements behind your management. Use it.

    • glub on 21/09/2020 - 14:59
      +1

      I'm more hoping to hear from people that have been through the same experience from the financial standpoint, all of the medical professionals I saw would not give me straight answers about it and were basically like you need to contact PHI and find out what would be covered.

      • [Deactivated] on 21/09/2020 - 15:08

        There are dozens of insurers and multiple policies within each insurer. Some patients may have claimed certain items on their policy so it also varies on an individual level.

        It's always best practice to just get item numbers and call your insurer/Medicare to work out the numbers.

  • blonky on 21/09/2020 - 14:43

    I had ortho (invisalign) and double jaw a few years ago, including 4 wisdom teeth removed under GA
    Had top hospital cover with extras and signed up same day I started ortho so had a 12 month waiting period

    From memory;

    Invisalign was 8k

    4x wisdom teeth
    $240 per tooth for the surgeon
    anaethetist $700
    hospital fees in Private (1.5 hours) $1500

    For the actual surgery:
    Surgeon 17k
    Anaethetist 6k
    Hospital stay 15k (?) 3 nights + (7 hour surgery) in Private

    The entire hospital stay component was covered by PHI, less $500 excess
    1/3rd of the anaethetist was covered by Medicare and PHI
    2k of the 17k surgery was covered by Medicare and PHI

    This is because the Medicare Benefits Schedule (MBS) determines the "cost" of the surgery, and that is all Medicare and ANY PHI will pay out, regardless of what the surgeon wants to charge.
    No-Gap would mean there's no out of pocket, but with a 15k difference no one is going to offer no-gap

    • glub on 21/09/2020 - 15:03

      Damn, this is not what I wanted to hear.

      So you were around $30k out of pocket even with PHI?

      I tried to look into this MBS but none of the surgeries I require were even listed, I even tried to go to the public dental hospital and see if I could only go through medicare but they will only accept people with some type of benefits scheme.

      So I don't even know how I find out what will be covered out of the surgeries I require.

      If you had been on a more premium PHI would they have covered a significant amount more?

      • blonky on 21/09/2020 - 15:10

        Yeah sounds about right, the surgery was 18 months after I commenced ortho so had time to put away funds each month

        And nope, no PHI wont pay out any more than the 2k that the MBS specified
        This was the main component of my surgery: http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=52…

        Its more of a health fund rather than insurance

      • [Deactivated] on 21/09/2020 - 15:13

        Public won't take you unless you are on some form of concession and have one of several conditions that is related to maxillo-facial deformities. (Eg. Cleft lip/palates, treacher-collins, etc…)

  • screensaver on 21/09/2020 - 20:54

    Look into the Medicare Safety Net Scheme, I dont know much about it, and also medical expenses were once tax deductible

  • Cynicaloflife on 27/09/2020 - 22:41

    If you are in Victoria, there is a way to get the surgery done for free. Be free to PM me if your interested. However, there is no avoiding the cost for braces.

    Alternatively, if cost is a hindrance going back to the UK for treatment at NHS or staying with the existing open bite are an option.

    I wouldn't recommend going overseas for surgery as the orthodontist and the OMS have to work in Tandem. So a clear communication is important.

  • Gelato on 16/11/2020 - 22:32

    Don’t recommend doing it overseas, the surgery and the braces need to be very well coordinated so you’d rather deal with both parties in one city over the span of few years

  • ozmian on 18/11/2020 - 20:16

    Had lower jaw surgery braces and implants a root canal and veneers all up cost about $21-22k the surgery was probably the cheapest part.

    $500 excess per financial year so crammed in a hand surgery too. Found best surgeon and they had some gap free thing where whatever health insurance covered the rest would be waived so didn't cost me a bunch. Anaesthetic was usually $200 per go. Implants about $9k and braces about $10k. Veneers a few hundred for two and root canal maybe top end of $600 ish. Definately went local as each step had many visits and hands on attention required. Overall the surgery was fairly east able to slowly eat pasta etc after a fortnight and after three months was like nothing happened back to normal.

    Timed each around roll-over date to claim as much as possible but out of pocket a fair bit. Got about two months left to pay and it's all over. Started the journey in maybe Sept 2017.

  • Icorganization on 19/11/2021 - 16:34

    Cynicaloflife, I'm in Victoria and need jaw surgery, a Dr here tried to fix it with a genioplasy but he's botched me and cleaned me out financially, how do I get the surgery I need free?

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