Insurance Criteria & My Stats

What follows are the details of my particular case. Not especially interesting to read, simply the facts.

Before Exam
The results of the physical exam I had prior my SARPE and subsequent orthodontics are given here:

facial profile: convex
type: dolichocephalic
lower facial height: increased
symmetry: fair
lip competence: open at rest
nasolabial angle: normal
upper lip: retrusive
lower lip: retrusive
gingival display: normal
overjet: 15mm
overbite: -5mm
midlines: on
classification (molars): class II
classification (canines): class II
crowding (upper): mild
crowding (lower): mild
arch form (upper): narrow tapered
arch form (lower): broad square
frenum: normal
teeth abnormalities: only occludes on her second (3rd) molars, significant wear to all of her molars that have been taking the brunt of her bite of many years
curve of spee: moderate
tonsils: normal
perio concerns: lower 3-3, mild to moderate generalized recession
caries: none noted
oral hygiene: good
jaw joints: no clicking or popping today, good range of motion, good straight opening and closing, no hitches or stops

Diagnosis
The diagnosis given following the examination: Class II division 1 total open bite malocclusion with chronic temporomandibular dysfunction, and a history of facial trauma

Insurance
I am covered under a Blue Cross Blue Shield of Oregon health insurance plan with a 20% co-pay. Below I have pasted their policy/criteria regarding orthognathic surgery as pertains to my plan and I have noted in red the criteria relevant to my case.

Orthognathic surgery may be considered medically necessary to correct jaw and craniofacial deformities in the absence of obstructive sleep apnea when all of the following criteria (A-C) are met:

1. Significant functional impairment is documented as a result of illness, injury, congenital anomaly, or developmental anomaly. Significant functional impairment must be directly attributable to jaw and craniofacial deformities and must include one or more of the following:
   1. Chewing-induced trauma secondary to malocclusion
   2. Significantly impaired swallowing and/or choking due to inadequate mastication secondary to malocclusion
   3. Significant speech abnormalities (e.g., sibilant distortions or velopharyngeal distortion) which have not responded to speech therapy and are secondary to malocclusion
   4. Loss of masticatory or incisive function due to malocclusion or skeletal abnormality
   5. Airway restriction
      
2. Significant over- or underjet as documented by one of the following:
   1. In mandibular excess or maxillary deficiency, a reverse overjet of 3mm or greater
   2. In mandibular deficiency, an overjet of 5mm or greater
   3. Open bite of 4mm or greater
   4. Deep bite of 7mm or greater
   5. Less than six posterior teeth in functional opposition to other teeth secondary to a developmental or congenital growth abnormality (as opposed to a consequence of the loss of teeth)
3. The functional impairment and over- or underjet are not correctable with non-surgical treatment modalities.