My son was born with a unilateral cleft lip and pallete in August of 1999. His
surgeon recommended presurgical orthodontics (an appliance and process that helps
close the segments and lift nose) prior to his lip repair surgery. What the
orthodontist charged and the insurance company is willing to consider usual &
customary are two different worlds. I have had this under review and appeal a couple
of times already with no progress.
I would like to know if anyone else has had this procedure done, and what the
outcome was with the insurance company? I would not be so upset if they were
in the same ballpark. I think the bill was around $3,100 and the insurance
considers $650 usual and customary. It may be how the orthodontist coded the
procedure, but they do this on a regular basis.
Any feedback would be helpful, since it is hard to get a usual & customary fee
for a procedure that is so new.