One of the biggest questions I receive is: "Is jaw surgery covered by insurance?" The answer is that whether or not orthognathic surgery (corrective jaw surgery) is covered depends upon your medical insurer, but also on the way that your jaw surgeon submits the claim to your medical insurance. That’s key. If your surgeon can convince your insurance company that the surgery is medically necessary, meaning it has a medical necessity, that might go a long way toward getting you covered. More on medical necessity near the end of this story.

You are not alone in your quest to have your jaw surgery covered by insurance. Seek help from your surgeon and ask if your case is medically necessary.

Jaw Surgery is Major Surgery

Jaw surgery is major surgery. It is a much more involved procedure than wisdom teeth extraction. In fact, wisdom teeth extraction could be considered a walk in the park compared to jaw surgery. Whether or not your jaw surgery procedure will be covered by insurance can be figured out in a few different ways.

The easiest way to find out if your jaw surgery will be covered by your medical insurance is to look at your plan. I know that's rather vague, so let me describe what I mean.

Look for Your Medical Insurance Coverage PDF File

If you don’t have a coverage booklet you received at work or by mail, log in to the website for your medical insurance. Two examples are Aetna and Cigna. You should be able to find the kind of coverage you have for jaw surgery. If you’ve never logged in to your medical insurer on their website, it might be a little bit of a pain to get your account set up. You might need to call or do a few things to get it set, but once you do you’ll be glad you did.

Usually on your insurer's website, after you log in there will be a tab or section, maybe called plan or benefits, that will contain a PDF you can look at that coverage in detail. In order to find the section of the PDF that shows jaw surgery coverage, look for the words “oral,” "malliofacial," or "orthognathic." If you aren't seeing anything under those words, I recommend contacting your medical insurance company.

In case of emergency, I was given this pair of special scissors to cut my wires that kept my jaw wired shut. Getting your jaw wired shut sounds bad, but it ensures your bones heal in the right place.

Contacting Your Medical Insurance Company

Calling a medical insurance company by phone is probably the fastest way to get an answer, but it might have you sit on hold for quite a long time.

Most medical insurance companies allow you to submit a question via a request on their website. This will take less of your time so you can concentrate on other things, but you might not hear back for a few hours or days.

There's also the live chat option on some medical insurance websites, but I recommend talking to someone over the phone so you can communicate and not receive copy-and-paste responses from a live chat agent reading off a script.

Medical Necessity

Regarding the medical necessity that I mentioned earlier, I received full coverage from Cigna for my first jaw surgery in 2014. This happened after my jaw surgeon spoke over the phone with the insurance company and told them my case was medically necessary.

Unfortunately, if your case is not too severe and is fairly mild or normal, you may have trouble receiving coverage because it might not be considered medically necessary.

Personal Advice

So a lot of this was just general information, but let me provide some of my own personal advice.

Ask your surgeon about payment options and where the surgery will happen. My second surgery was at a medical center instead of a hospital, and cost around $14,000 out-of-pocket that I paid on a payment plan with zero interest. I had to give a down payment on the day of the surgery. It was kind of like buying a car. That amount included all appointments both before and after the surgery, and the surgery itself. It did not include orthodontics or braces or anything like that.

Jaw surgery in a hospital will likely cost much more than a small medical center, even after an insurance company talks a hospital down on the price the way that hospitals do these days, with those strange ways they negotiate.

Another good tip is to call around to different surgeons and ask about various payment plans and different ways that you can receive coverage. Further, some surgeons that perform jaw surgery will provide free consultations and they can advise you during that free consultation about whether or not your jaw surgery will be covered. Bring your medical insurance coverage booklet or plan PDF I mentioned earlier that can be found on your medical insurance website.

The final thing I have to say is that it's always a good thing to ask at your first consultation how many patients per year does the surgeon basically not do a 100% good job and have to redo their surgeries. I wish I asked this of my first surgeon. My second surgeon, who did a spectacular job and appears to have fixed my jaw for life, told me that he usually only had to redo one patient's surgery per year, which was great to hear.

Jaw Surgery Can Be Covered

Jaw surgery is covered by medical insurance in some cases. It's much easier than it seems to reach out to your insurance company to ask what is covered. Also talk to your surgeon and ask him or her if they believe your case is a medical necessity. If they deem it medically necessary for you to have your surgery, you might even receive full coverage like I did for my first surgery.

I'm fully open to questions. See below for comments. Also, if you did or did not receive coverage, share your story so others can read. Anyone who's gone through jaw surgery knows what it's like whenever they haven't begun the process yet. It's daunting. It's always good to hear from a few people who have fully recovered and are living life normally.

This post is one in a series of the most asked jaw surgery questions.

Is Jaw Surgery Covered by Insurance?