Insurance and costs
Is Jaw Surgery Covered by Insurance?
Corrective jaw surgery, TMJ surgery, and sleep apnea surgery are medical procedures, and medical insurance often covers them when they treat a functional problem. Here is how coverage works and what you may pay.
Coverage
What Insurance Usually Covers
Medical plans generally cover surgery that treats a functional problem when it is documented as medically necessary. Coverage depends on your specific plan, so we check it before anything is scheduled.
- Corrective Jaw Surgery
- Covered by many plans when the jaw discrepancy causes problems with biting, chewing, speech, or breathing, documented with records and measurements. Some plans set a minimum discrepancy.
- TMJ Surgery
- Many plans cover arthroscopy, arthroplasty, and joint replacement once conservative treatment has been tried and symptoms persist or worsen.
- Sleep Apnea Surgery
- Usually covered when obstructive sleep apnea is documented on a sleep study and CPAP has been tried. Nasal airway surgery performed in the same operation is billed to the same plan.
- Nerve Repair and Pathology
- Billed to medical insurance as treatment of an injury or disease.
Your share
What You Pay for Surgery
Your share of the surgeon's fee is set by your plan: its deductible, coinsurance, and out-of-pocket maximum. With larger operations, patients often reach their plan's out-of-pocket maximum.
Other bills
Bills From Other Providers
The hospital, the anesthesia team, and in some cases pathology, radiology, or an assistant surgeon will bill your insurance separately. Before surgery, we agree on the hospital where your case will be booked, so you can confirm that the facility is in network with your insurance plan.
Surgery is performed at Hackensack University Medical Center, St. Joseph's University Medical Center, Robert Wood Johnson University Hospital, Saint Peter's University Hospital, and Jersey City Medical Center.
Orthodontics
Orthodontic Costs
Most corrective jaw surgery is done together with orthodontic treatment before and after surgery. Your braces are provided and billed for by your orthodontist, usually through dental insurance. Dental plans often cover only part of orthodontic treatment, up to a lifetime maximum, and many cover none for adults, so many patients have some out-of-pocket costs for this part of their care.
Your orthodontist can give you an estimate for the orthodontic phase. We coordinate with your orthodontist so the two phases fit together.
Aesthetic
Aesthetic Procedures
Custom facial implants, neck contouring, and any procedure performed for appearance alone are not covered by insurance. You receive a written quote after your consultation. When an aesthetic procedure is added to a covered operation, only the aesthetic portion is billed to you.
Questions
Common Questions
Is jaw surgery covered by insurance?
Often, when it corrects a functional problem. We check your plan and request prior authorization before surgery.
Is TMJ surgery covered by insurance?
Many plans cover TMJ surgery after conservative treatment has been tried and symptoms persist or worsen. We check your specific plan.
What if my plan denies coverage?
We can appeal with additional documentation. If the plan still declines, we discuss self-pay options with you before anything is scheduled.
Does insurance pay for braces before jaw surgery?
Orthodontics is usually a dental benefit with limited coverage, so many patients have some out-of-pocket cost. Your orthodontist can estimate it.
Next step
Talk It Through in Person
Consultations in Paramus and Old Bridge, New Jersey. No referral is needed.