Insurance Coverage for Alveolar Bone Graft

[smains@shentel.net]

My 10 year old son who was born with a unilateral cleft lip and palate is scheduled for alveolar bone graft and fistula repair surgery, soon. My insurance company, Trigon Blue Cross Blue Shield (Federal Program) has covered his previous lip and palate surgeries. However, I'm concerned that they will deny coverage for the bone graft surgery. The policy covers congenital anomaly corrections, but elsewhere states it does not cover surgical procedures that involve teeth or their supporting structures such as ...alveolar bone. In addition, Trigon (Federal Program) no longer pre-authorizes this type of procedure, which was attempted by the surgeon. Has anyone had Trigon (Federal Program) cover their bone graft surgery? Thanks! Steve

[Renee (]

Steve-
My daughter just went through this same surgery on June 4th. Is your company self insured? My husband's company is and his corporate benefits rep can override what ever the insurance company says. We have to contact them every time Kristyn has a Dr. appt with her surgeon or a surgery scheduled. They have always gotten it approved at our maximum benefit of 90%.. It might be worth checking into... I hope all goes well with your son. My daughter did fantastic. I'm not for sure how extensive his is, but her surgery lasted 2 hrs and Dr. Steven J. Smith in Knoxville, Tn did her surgery. He's great. He took the bone from her hip and that was the area that gave her some discomfort. Her mouth felt fine...Keep me posted. Best wishes!!!! Renee