Insurance Coverage
Insurance for oral and maxillofacial surgery can be confusing. Some policies cover surgery as a medical expense, some cover surgery as a dental. Jaw reconstructive surgery, setting of fractured jaws, and removal of tumors are commonly covered as medical expenses. Impacted wisdom teeth are sometimes covered by medical insurance. Dental insurance partially covers the extraction of impacted and erupted teeth along with most other office oral surgical procedures. Newer procedures in implant reconstruction are generally not covered. Many insurance companies cover anesthesia. Some do not.
Some companies offer many different dental and medical plans. Some companies combine dental and medical coverage. This insurance alphabet soup changes policies and guidelines weekly. At times, it is almost impossible to accurately estimate your insurance co-payment. Many insurance companies will not give out fees until after the treatment is completed. Dealing with these companies can be difficult and time consuming. Make sure you keep your doctor informed of any change to your insurance. It is important that all information about you and your insurance be current.
In recent years managed care has replaced the majority of traditional indemnity insurance contracts. Many managed care contracts limit access to oral and maxillofacial surgeons. Many limit the care provided by oral surgeons and all limit the reimbursement for their services. Reimbursement in some cases dropped to usual, customary, and reasonable fees charged in the late 1970's.

Most surgeons attempt to participate in as many managed care contracts as possible. The will often only participate in those managed care contracts that reimburse oral surgical services at a fair rate and allow for reimbursement in such a fashion as not to affect quality. Some managed care contracts do not recognize the additional expense of the oral surgeons outpatient surgical facility and do not reimburse at a high enough level to compensate the surgeon for his skills, reimburse at a level to compensate the advanced training of the staff or provide necessary reimbursement for the advanced technology present in this surgical facility.

Possible Coverage Limitations
Most health plans do not pay for the entire cost of your care. Your policy may feature one of the following limitations:

• A list of exclusions of certain procedures;
• A CO-payment provision;
• A dollar limit on covered services;
• A coinsurance clause;
• A table of allowance; a deductible clause;
• Or any combination of the above

Some health insurance contracts contain ìtable of allowancesor a schedule of benefits.These tables are not fee schedules, although they may be described as such in your contract. There are lists of the amounts toward the surgeon's actual fees which your insurance company will pay under the terms of the contract. In some cases, these amounts may be less than the actual fees.

CO-Payment

All co-payments are payable when you check in at the front desk.

HMO Patient

A patient with a problem that they expect to be covered by medical insurance (biopsies, tumors, TMJ, infections, jaw deformities), must usually have a referral from their primary care physician. A referral from a dentist is usually not adequate for medical insurance coverage. Obtaining a medical referral is the patient's responsibility. If you do not have a referral, your medical insurance company will not pay for your treatment.

Medicare Patients

Medicare pays us directly for your care. You are responsible for any deductible and coinsurance. Dental procedures (extractions, implants) are not covered by Medicare. If Medicare denies your procedure, you are responsible for the charges.

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Breathing Difficulties
Some people do complain of minor breathing difficulties. This is usually a temporary problem and should go away shortly. However, a discussion of emergency breathing situations should be discussed with your surgeon. Most Doctors will recommend that you keep a set of wire cutters or nail clippers handy for the extremely rare emergencies when you might need to cut your wires.

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Oral Hygiene
Oral hygiene is important!
Discuss the various tools available such as sonicare and waterpik products with your doctor. These are very good products that can actually become comforting during this time period. Poor oral hygiene may result in infection, a bad taste to the mouth and increased swelling of the face.

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Exercise
Returning to workouts is different for everyone. It can depend on your recovery ability and prior health status. You may be able to do some light workouts during the recovery period but the main problem for many wired jaw patients is the inability to take in enough air. Good luck and good workouts!

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Fear
Fear is a natural part of this during all phases of the process. However, the vast majority of oral surgeries are problem free. The problems that do arise are usually minor. There are many anxiety and fear techniques that can be used. Here is one a patient recently recommended:
Keep repeating to yourself something like, "I can breath I'll be okay," this will pass. Take a slow deep breath in through your nose to the count of at least 5, hold it for two seconds then slowly let it out. This lets your physical body know you are okay. Then do something, anything. Count the pennies in the penny jar and roll them. TV watching is not a good choice, something involving your body like walking is better. Anything that makes your brain work on something else. Your mind will likely flash back to the bad feelings, repeat your "I'm okay" saying, the deep nose breath, and return to doing something.î
During the period in which you are wired shut you may need to use self-talk to improve your spirits. Believe that with each day your condition will improve. Put effort into other activities so that you worry less. Try to do activities that relax you. Make use of your support group such as family and friends. Good luck, you will do fine!

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Opening Your Mouth
Difficulty in opening your mouth widely and discomfort upon swallowing should be anticipated. Decreased opening and range of motion of the lower jaw, is especially common. This is a normal response by the muscles that control the lower jaw. Complete return to normal range of motion may take from several weeks to several months depending on the patient.

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Pain
Unfortunately, most oral surgery is accompanied by some degree of discomfort. Severity of postoperative pain will depend on the procedure and your physical condition.
Take the pain medication usually prescribed as directed. If none has been prescribed, discuss this with your doctor. Taking the pain medication with soft food and a large volume of water will lessen any side effects of nausea or stomach upset.
Application of an ice bag can also help relieve discomfort.
While under the influence of any pain medication, it is advised that you not drive a car, operate machinery, climb ladders, or make any important financial decisions. It is also advised that you refrain from any strenuous activity, as this may lead to an increase in swelling as well as the potential for injury because of impaired coordination caused by narcotic medications. Whenever possible, use nonsteroidal anti-inflammatory medications such as Advil, Motrin, Aleve, or Tylenol.

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Sleeping
Some patients occasionally have problems sleeping during the recovery period. They may also have nightmares and dreams associated with their condition. This is usually anxiety related and relates to the patients uncertainty about their situation.

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Surgery
It is perfectly normal to feel a little stressed and nervous before surgery. You may not sleep much the night before surgery (don't forget to eat all your favorite foods that evening!)
Everyone has a different post-op experience, but many say the experience wasn't nearly as bad as expected.
Try to be as prepared as possible before surgery, so you will have some feeling of control over the situation. Stock up on all the foods and other things you will need, and also maybe get some videos, books, magazines or puzzles that you really enjoy. For a little while, your only job will be to rest and heal, so prepare to pamper yourself. One week may be too soon to go back to work; you will probably feel (and look) better by then, but your energy will be low for awhile, and you'll need to listen to your body.

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Swelling
Immediately following surgery apply an ice bag over the affected area. Use 20 minutes on and 20 minutes off for 24 hours to help prevent development of excessive swelling and discomfort. If an ice bag is unavailable, simply fill a heavy plastic bag with crushed ice. Tie end securely and cover with a soft cloth to avoid skin irritation.
Some believe swelling is worse in the mornings, right after awakening. This is probably because of the pressure that sleeping on pillows exerts on healing bones. If this is the case, swelling usually diminishes in an hour or two.

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Bruising
Discoloration of the IV site or the facial skin adjacent to the surgical site can occur because of age, medications (aspirin, motrin, anticoagulants), and skin complexion. While cosmetically undesirable, this skin discoloration is harmless and will resolve over the next several days on its own without any medical intervention.
Bruising may be around for quite some time. In rare cases it lasts for more than a month. However, most of the bruising is gone in a week or so.

Cosmetics are invaluable as a temporary camouflage, and they can usually be applied any time during the recovery period.

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Diet
Following oral surgery it is necessary to maintain a proper diet.
The worst part of this entire process is having your mouth wired (or rubber banded, depending on the severity of your surgery). So, for four weeks or longer you will be forced to live off of liquid and puréed foods. It isn't fun, but you'll just have to deal with it. That, of course, is the main reason for this web site!
You should expect some weight loss. You can expect to lose between 10-15% of your body weight before the loss will equalize and your metabolism adjusts to liquid food only. Using the recipes in the Soups and Shakes Liquid Cookbook the author only lost 6 pounds. You may lose more or less.

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Drinking
Drinking plenty of fluids with meals and in between meals is essential in the post-operative period. If upper posterior (back) teeth have been removed please avoid using a straw. Stay away from alcoholic beverages.