#98 – Karim Hachem – How Do I Get My Jaw Surgery Covered by Insurance?

Ron sits down with Karim Hachem, co-founder of Suade Health. Karim shares his personal battle of getting reimbursed for out-of-network surgery and reveals the specific strategies patients need to use to avoid financial ruin when financing jaw surgery. They cover network gap exceptions, how to navigate denials for "experimental" airway expanders, and why an authorization letter doesn't guarantee you'll get a single penny back.

Karim's Website (Suade Health)

https://www.suade.health/about-us

1:1 Coaching with Ron (Now Inside The Joint)

https://jawhacks.com/coaching

JawHacks Newsletter (Substack)

https://substack.com/@jawhacks

And More on the Website

https://jawhacks.com/

Chapters

00:00:00 - Intro

00:00:30 - Can You Get Insurance for Out-of-Network Surgeons?

00:04:23 - How Insurance Turned $7,500 Into Zero (Karim's Story)

00:09:30 - The "Allowed Amount" Scam Explained

00:24:03 - Timeline: When to Start Your Insurance Strategy (60-90 Days)

00:27:57 - Network Gap Exceptions and Single Case Agreements

00:34:50 - Does Surgeon Choice Affect Approval? (Out-of-State Benefits)

00:37:49 - Open Enrollment Strategy: How to Pick the Right Plan

00:42:48 - Plan Challenges: Why Medicaid/HMO Plans Are Difficult

00:46:05 - Choosing Between PPO, EPO, and HMO Plans

00:56:11 - How Suede Health Works With Patients and Surgeons

01:16:24 - Medical Necessity Pathways: OSA and Malocclusion

01:26:49 - Getting Coverage for MARPE and Nasal-Maxillary Expanders

01:37:00 - Karim's Jaw Surgery Results: 21mm Advancement

01:41:20 - Life After Surgery: Cortisol, Sleep, Migraines, and ADHD Gone

01:45:50 - Final Thoughts: Is Jaw Surgery Worth It?

NO MEDICAL OR DENTAL ADVICE. Ronald Ead and JAWHACKS, LLC, dba JawHacks (collectively, "we") does not give medical advice. We are not licensed medical professionals. The information provided in this video is for educational and informational purposes only and should not be construed as medical advice. Always seek the guidance of a qualified healthcare provider with any questions you may have regarding your health or a medical condition.