Orthognathic Surgery Sample Clauses
The Orthognathic Surgery clause defines the terms and conditions under which jaw surgery (orthognathic surgery) is addressed within the agreement. It typically outlines the circumstances in which such surgery is considered medically necessary, the process for obtaining pre-authorization, and any coverage limitations or exclusions that may apply. For example, the clause may specify that only certain types of jaw misalignments qualify or that prior approval from a medical review board is required. Its core function is to clarify the scope of coverage and the requirements for accessing benefits related to orthognathic surgery, thereby preventing misunderstandings and disputes over eligibility and payment.
Orthognathic Surgery. This plan does not cover procedures to make the jaw longer or shorter, except orthognathic surgery and supplies for medically necessary treatment of Temporomandibular Joint (TMJ) Disorders, Sleep Apnea or Congenital Anomalies. See the Temporomandibular Joint (TMJ) Disorders and Surgical Services benefits for additional coverage information.
Orthognathic Surgery. The Plan does not provide Benefits for Orthognathic Surgery, except as covered under section 4.B.58.
Orthognathic Surgery. A branch of oral surgery dealing with the cause and surgical treatment of malposition of the bones of the jaw and occasionally other facial bones. Orthotic Device. A device that restricts, eliminates, or redirects motion of a weak or diseased body part. Out-of-Pocket Cost. The portion of the cost of services for which the Member is personally responsible. Out-of-Pocket Costs include Copayments, Coinsurance, and Deductibles.
Orthognathic Surgery. (surgery to reposition the upper and/or lower jaw) which is Medically Necessary to cor- rect a skeletal deformity; or
7. Dental and orthodontic services that are an integral part of Reconstructive Surgery for cleft palate repair. No benefits are provided for:
1. Services performed on the teeth, gums (other than for tumors and dental and orthodontic services that are an in- tegral part of Reconstructive Surgery for cleft palate re- pair) and associated, periodontal structures, routine care of teeth and gums, diagnostic Services, preventive or periodontic Services, dental orthoses and prostheses, in- cluding hospitalization incident thereto;
2. Orthodontia (dental services to correct irregularities or malocclusion of the teeth) for any reason (except for or- thodontic services that are an integral part of Reconstruc- tive Surgery for cleft palate repair), including treatment to alleviate TMJ;
3. Dental implants (endosteal, subperiosteal or transosteal);
4. Any procedure (e.g. vestibuloplasty) intended to prepare the mouth for dentures or for the more comfortable use of dentures;
5. Alveolar ridge surgery to the jaws if performed primarily to treat disease related to the teeth, gums or periodontal structures, or to support natural or prosthetic teeth; or
6. Fluoride treatments except when used with radiation therapy to the oral cavity. See Principal Limitations, Exceptions, Exclusions, and Re- ductions, General Exclusions for additional Services that are not covered.
Orthognathic Surgery. (surgery to reposition the upper and/or lower jaw) which is Medically Necessary to cor- rect skeletal deformity; or
Orthognathic Surgery. The repair or replacement of any orthodontic appliance, unless specifically listed as a Covered Dental Service.
Orthognathic Surgery. (surgery to reposition the upper and/or lower jaw) which is Medically Necessary to correct skeletal deformity; or Dental and orthodontic services that are an integral part of Reconstructive Surgery for cleft palate repair. This benefit does not include:
1. Services performed on the teeth, gums (other than tumors and dental and orthodontic services that are an integral part of Reconstructive Surgery for cleft palate repair) and associated periodontal structures, routine care of teeth and gums, diagnostic services, preventive or periodontic services, dental orthoses and prostheses, including hospitalization incident thereto;
2. Orthodontia (dental services to correct irregularities or malocclusion of the teeth) for any reason (except for orthodontic services that are an integral part of Reconstructive Surgery for cleft palate repair), including
3. Any procedure, e.g. vestibuloplasty, intended to prepare the mouth for dentures or for the more comfortable use of dentures;
4. Dental Implants (endosteal, subperiosteal, or transosteal). 5. Alveolar ridge surgery of the jaws if performed primarily to treat diseases related to the teeth, gums or periodontal structures or to support natural or prosthetic teeth; 6. Fluoride treatments except when used with radiation therapy to the oral cavity. See Section VI. Exclusions and Limitations for additional services that are not covered.
Orthognathic Surgery. Orthognathic surgery to repair or correct a severe facial deformity or disfigurement that orthodontics alone cannot correct; provided: . the deformity or disfigurement is accompanied by a documented clinically significant functional impairment, and there is a reasonable expectation that the procedure will result in meaningful functional improvement, or; the orthognathic surgery is Medically Necessary as a result of tumor, trauma, disease, or . the orthognathic surgery is performed prior to age 19 and is required as a result of severe congenital facial deformity or congenital condition. Repeat or subsequent orthognathic surgeries for the same condition are covered only when the previous orthognathic surgery met the above requirements, there is a high probability of significant additional improvement as determined by the utilization review Physician. GM6000 06BNR10
Orthognathic Surgery. Services and supplies for orthognathic surgery. By "orthognathic surgery," We mean surgery to manipulate facial bones, including the jaw, in patients with facial bone abnormalities resulting from abnormal development to restore the proper anatomic and functional relationship of the facial bones. This exclusion does not apply to orthognathic surgery due to a temporomandibular joint disorder, Injury, sleep apnea or congenital anomaly. Over-the-counter contraceptive supplies and oral contraceptives, except where included under the Prescription Medication Benefits Section of the Contract. Items that are primarily for comfort, convenience, cosmetics, environmental control or education. For example, We do not cover telephones, televisions, air conditioners, air filters, humidifiers, whirlpools, heat lamps and light boxes. Physical exercise programs or equipment, including hot tubs or membership fees at spas, health clubs or other such facilities. This exclusion applies even if the program, equipment or membership is recommended by the Member's Provider. Private-duty nursing, including ongoing shift care in the home. Services and supplies related to reversals of sterilization. Services and supplies for treatment of an Illness, Injury or condition caused by a Member's voluntary participation in a riot, armed invasion or aggression, insurrection or rebellion or sustained by a Member arising directly from an act deemed illegal by an officer or a court of law. Self-help, non-medical self-care, training programs, including: diet and weight monitoring services; childbirth-related classes including infant care and breast feeding classes; and instruction programs including those to learn how to stop smoking and programs that teach a person how to use Durable Medical Equipment or how to care for a family member. This exclusion does not apply to services for training or educating a Member when provided without separate charge in connection with Covered Services or when specifically indicated as a Covered Service in the Medical Benefits Section (for example, nutritional counseling, diabetic education and teaching doses for Self-Administrable Injectable Medications). Services and supplies provided to You by a Member of Your immediate family. For purposes of this provision, "immediate family" means parents, spouse, children, siblings, half-siblings, parent- in-law, child-in-law, sibling-in-law, half-sibling-in-law, or any relative by blood or marriage who shares a residence w...
Orthognathic Surgery. Some patients have significant skeletal disharmonies, which require orthodontic treatment in conjunction with orthognathic (dentofacial) surgery. There are additional risks associated with this surgery, which you should discuss with your oral and/or maxillofacial surgeon prior to beginning orthodontic treatment. Please be aware that orthodontic treatment prior to orthognathic surgery often only aligns the teeth within the individual dental arches. Therefore, patients discontinuing orthodontic treatment without completing the planned surgical procedures may have a malocclusion that is worse than when they began treatment! Excellent oral hygiene is essential during orthodontic treatment as are regular visits to your family dentist. Inadequate or improper hygiene could result in cavities, discolored teeth, periodontal disease and/or decalcification. These same problems can occur without orthodontic treatment, but the risk is greater to an individual wearing braces or other appliances. These problems may be aggravated if the patient has not had the benefit of fluoridated water or its substitute, or if the patient consumes sweetened beverages or foods.