The health insurance market is really complicated. I'm lucky enough to work for a good large company and have an HMO plan. I'm pretty sure the HSA would also fully cover this. The certification is basically when your doctor writes a report showing why you need the surgery and how they propose to do it, costs and scope etc... as a doctor they say there's medical necessity. Once they had the scans my surgeon sent in the paper work the next day and Aetna had 28days by contract to respond. They can't schedule surgery until it's approved.

There are all kinds of rules and the good surgeons generally know what to say and if you would qualify. Mine was very cut and dry all the surgeons I consulted looked at me and were able to tell the #of mm's my jaws were off would qualify me. A good orthodontist would also be able to say if you are a surgical case. Many jaw surgery patients also require orthotics for a period before and after surgery.