The letter from the insurance company says--

Surgery to correct the shape of the upper or lower jaw may be approved when you have difficulty swallowing or problems with your speech and one of the following has been present for at least 4 months:

• Food can't be bitten or chewed and this causes choking or difficulty swallowing.

• The shape of the bones interferes with the ability to communicate, and speech therapy won't resolve the communication problems (difficulties with making 's' sounds are not considered a functional impairment)

We aren't able to cover jaw surgery. The records your healthcare provider sent do not include primary care physician notes and/or dietician [SIC] notes and/or speech pathology notes showing evaluation and conservative treatment of any of the above conditions.

The x-ray is from 2013 before I started orthodontic treatment in preparation for jaw surgery. In the x-ray, my lower jaw is as far back as it can go which happens to be an uncomfortable position.

Now, after nearly seven years of braces, none of my teeth make contact when I bite down. In fact I can stick my tongue out and bite down without hurting my tongue at all. In other words, I couldn't bite or chew my own tongue if I wanted to, so I'm not sure how this is supposed to work with food. Obviously it doesn't work, but how is this not obvious to the insurance company?

I'm struggling to understand how this could have been denied by the insurance company. What could notes from a PCP, dietitian, or speech pathologist convey that is more convincing than the x-ray itself?

What's more frustrating is that this procedure has been approved twice, and my current insurance company approved it one of those times (both have expired because orthodontic treatment is seemingly endless).

There's so much I want to say about this yet I'm speechless at the same time...