Tips for those navigating the Kaiser system

Hello Everyone,

This is for all those who are getting their jaw surgery through Kaiser. I’m not a big fan of Kaiser in general, but for jaw surgery I switched to them for this specific procedure.

From my consultations and research, Kaiser seems to be the “best” when you factor in surgeon skills AND costs. Yes, you can probably go to LACOMS where their surgeons are probably better, but you are looking at anywhere from $25k-60k out of pocket, depending on insurance.

First, with Kaiser, you do not have to go through the whole insurance approval, “is it medically necessary” process like you have to do with other insurance companies. If your orthodontist says you are a surgical candidate and the Kaiser surgeon agrees after the first consultation, you are covered and ready to go. You don’t need to take any sleep tests or have your surgeon submit paperwork to the insurance for authorization and deal with the back and forth. It’s pretty straight forward.

Second, many Kaiser surgeons are experts in this. This is literally all they do at Kaiser. They do these cases week in and week out. Other surgeons may do this on the side because they try to be a jack of all trades. But with Kaiser, this is their sole specialty. As a result, they’ve done hundreds of cases and seen what is best practice. This leads me to my other point, which is that many surgeons in private practice came from the Kaiser system because of the training expertise and experience they gained.

Third, it’s the cost. Now, this is dependent on your plan, so please verify costs with your plan benefits. But with Kaiser, I am looking at about $300-$400 TOTAL for this procedure. Yes that’s right. $150 for the surgery, $25 for doctor visit co-pay before and after surgery, and then some prescribed medications.

Great, so you’re with Kaiser now, what do you do? Many Kaiser systems will not give you a surgery date until you are cleared for surgery, meaning that your teeth are now aligned to where the surgeon wants them. This is in done in coordination with your orthodontist.

The moment your orthodontist clears you for surgery, call the maxillofacial department at Kaiser immediately to let them know. If you do not hear from anyone or are having trouble getting ahold of someone there, message the surgeon on the KP website. That is what I did and it expedited the process.

When you get cleared for surgery, you’re going to get added to Kaiser’s waitlist. Depending on which location you are in, it can be anywhere from 6-12 months. For me, the scheduling coordinator told me expect 8-10 months. DO NOT GIVE UP. Do two things:

1) keep calling every week seeing if a spot opened up 2) Important: have your orthodontist directly reach out to the surgeon themselves. If you are still looking at which orthodontist to go with, this is where it is important to also select one who has a close relationship with your surgeon. My orthodontist emailed the surgeon, and I got a phone call within 48 hours saying they have a spot opened up 3.5 months away.

When you get a surgery date, they will make you get a CT scan. Please do this as soon as possible to avoid any delays. Second, you will have a long pre-op appointment where they will take measurements and everything. This is normally scheduled one month before your surgery date. IT IS VERY IMPORTANT YOU DOCNOT MISS THIS APPOINTMENT. Clear your calendar and cancel every other plan. If you don’t attend this appointment and there are no other dates available near to reschedule, they are going to have to push your surgery date back.

After your surgery, you will have 5 post-op appointments scheduled. These dates will be already scheduled for you when they give you your surgery date.

Also, I highly recommend you get your teeth cleaned by your dental hygienist couple days before your surgery. I say this because you want to minimize plaque build-up as much as possible, especially if you can’t brush normally after surgery. Once you get your surgery date, call your dental office and make an appointment. And if they say they are booked, tell them you’re having jaw surgery. They will move stuff around to accommodate you.

I hope this helps! I have a 8mm overbite and am getting surgery in 2 months.