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Does Your Insurance Cover Distraction Osteogenesis?

Distraction osteogenesis (DO) is a method that Dr. Steve A. Sedaros uses to treat selected defects and malformations of the facial and mandibular bones. Distraction osteogenesis (aka bone distraction) can be used to widen the jaw by gradually moving the bones.

WHAT ORAL AND FACIAL SKELETON ISSUES CAN BONE DISTRACTION ADDRESS?

For the most part, distraction osteogenesis is used to address the oral and facial defects most commonly associated with:

  • lack of bone due to a traumatic event;
  • severe mandibular atrophy caused by the early loss of teeth; and
  • defects due to cancer.

WHICH IS MORE INVASIVE, TRADITIONAL SURGERY OR DISTRACTION OSTEOGENESIS?

When comparing surgical procedures for the same issue, bone distraction surgery is much less invasive than its traditional surgery counterpart. Moreover, distraction osteogenesis is typically an outpatient procedure.

Traditional surgery tends to produce more pain and inflammation than is experienced with distraction osteogenesis surgery for a similar condition. Furthermore, unlike traditional surgical procedures, bone distraction surgery does not require any bone or soft tissue grafts; both of which require another surgical site.

DOES DISTRACTION OSETOGENESIS HURT?

During the surgical procedure, patients receive general anesthesia. Once the surgery is complete, patients receive pain medication and, possibly, antibiotics.

When the bone distraction device is activated, some patients do experience mild discomfort. This discomfort can be compared to the feeling an individual experiences when having his or her braces tightened.

WHAT TO EXPECT DURING RECOVERY

Just as with any surgery, patients should expect some inflammation and pain as they recover. However, Dr. Sedaros provides his patients with medication to ensure they remain as comfortable as possible following their procedure.

WILL THERE BE VISIBLE SCARS ON THE PATIENT’S FACE AFTER A DISTRACTION OSTEOGENESIS PROCEDURE?

Dr. Sedaros performs the entire surgery inside the patient’s mouth and he places the distraction appliance within the mouth as well; therefore, facial incisions are not necessary.

CAN BONE DISTRACTION BE USED TO ADD BONE TO THE JAWS?

Yes, thanks to recent advances in the field of oral and maxillofacial surgery, Dr. Sedaros can use bone distraction as opposed to bone grafts to add bone to the jaw. Once the new bone has formed, it can serve as a foundation for dental implants.

DOES HEALTH INSURANCE COVER DISTRACTION OSTEOGENESIS?

The reason bone distraction is being performed usually determines whether or not a health insurance company will cover the procedure. If the procedure is medically necessary, then health insurance companies are required by Florida state regulations (Florida Statutes, Section 627.66911) to cover at least a portion of the procedure. For example, mandibular osteogenesis and maxillary distraction are often considered medically necessary because mandibular osteogenesis can be used to alleviate an upper airway obstruction and maxillary distraction preserves the patient’s vision.

FLORIDA’S STATE REQUIREMENTS MUST BE MET TO ENSURE COVERAGE

Orthognathic surgery for the correction of skeletal deformities of the mandible or maxilla must meet the state’s definition of medical necessity, which includes:

  1. A skeletal deformity which may include: vertical discrepancies, antero-posterior discrepancies, trauma, illness, asymmetry issues and/or transverse discrepancies.
  2. Functional impairment caused by a skeletal deformity which may include: difficulty swallowing,  difficulty chewing, Myofascial pain that lasts for at least six months (and has neglected to respond to more conservative therapies), obstructive sleep apnea, and/or speech impediments that do not respond to other therapies.
  3. All of the following documentation requirements must be met: a documented medical history, description of the skeletal deformity, results of the physical examination, X-rays (cephalometric and panorex), cephalometric tracings and analysis (to study skeletal relationships), anterior posterior radiographs (to verify asymmetry deformities) and the treating physician’s medical records that document the evaluation, diagnosis and previous treatments used to manage the patient’s functional impairment(s) as well as photographs demonstrating the skeletal deformity.

COSMETIC SURGERY IS NOT CONSIDERED A MEDICAL NECESSITY

Any orthognathic surgery performed solely for cosmetic reasons is not considered a medical necessity; therefore, the state of Florida does not require health insurance companies to cover these kinds of procedures.

If you reside in the vicinity of Melbourne, Fla., and you are in need of an experienced oral surgeon, please contact Sedaros Oral Facial Surgery and Dental Implants today at 321.610.7868. Or, if you prefer, you can contact us with our online form by clicking here.