Saturday, February 21, 2009

How it began

So I have never had a blog before but felt the need to tell my story and document my journey.

I have never had anything near a perfect smile. As I got older I could never afford braces until now. I am 28 today and will turn 29 in the next month. While in post secondary school my jaw started causing me trouble. My jaw started clicking and would not open completely. The pain was not constant when that started, but as the years past the pain was constant and brought headaches with the pain.
I have now completed school and can afford braces to correct alignment of my teeth. I have so long wanted braces but my parents didn't have the knowledge that I needed braces as a child. I now have dental insurance that will pay for a portion of the braces.

In Dec/08 I made an appointment with an Orthodontist, selected by the dental insurance company. The office I went to was dirty and unpleasant. The orthodontist looked at my teeth for 5 min max; I don't even think it was that long. He told me that I would have to to wear braces for 24 to 30 months, and that he could not correct all of the issues with my mouth without surgery but he would try. He told the insurance company that braces where needed; for me this meant I would not have to pay for the complete cost of braces.

When I was at that office I really felt like I was at the poor mans office and the orthodontist was working more for the insurance company then for me. So what I did was select another orthodontist that was covered by my dental. I really didn't know who to select especially since I recently moved to the bay area and didn't know anyone in my area to help with this selection. So what I did was choose an orthodontist based on the area that was known for better everything. I went to one in Berkeley.
The orthodontist that I saw, Dr. O took the time to record what he saw and what he thought the treatment needed was. This made me feel a lot better in comparison to the first orthodontist.

So the results where both expected and disappointing. I would need braces and orthognatic (jaw) surgery. Dr. O would not put braces on me if I did not get the surgery. I went for the Oral and Maxillofacial surgeon (OMS) consultation. According to the OMS if I got braces without this surgery I would be back to see him but to get my front teeth removed because the braces would pull the roots of my teeth. I really want to keep my own teeth.

So I had the OMS submit an request for approval. On Feb 2, 2009 the medical insurance company sent their first letter of denial saying that orthognatic surgery was only covered for people 19 years and under. That doesn't make sense, many people get this surgery done. I did not wake up one day and say " hey I'll put myself though 3 surgeries for the fun of it."

What I need done are 1st surgery - I will have my pallet suture split, the 2nd surgery - the upper and lower jaw need cut in to 2 or more pieces and movement and bracing of those pieces.

I called the medical insurance company to find out how they came to the conclusion that my age excluded me from coverage. The first person I spoke with indicated that there where no age restriction on the treatment codes supplied by the OMS office.
I called a second time and that person sent my file for second review.
I called a third time to find out if I could do anything else to be approved. Person 3 indicated that I needed to get the benefit booklet and submit an appeal to the medical insurance company.
I called a fourth time just to get more information as my husbands admin office did not have a copy of the benefit booklet (they only had the summery which tells you nothing). I spent over an hour with this person. I am sooooo glad that I called the fourth time because on February 10th another letter was complied indicating that I was approved for the 3 surgeries.

When I thought I would have to pay for the surgeries myself, I found out that some hospitals will give a discount to cash patients. So, if you think you will have to pay out of pocket, call your local hospital's accounting department and see what they'll do for you. You can also check out teaching hospitals, I heard that they will give a discount on the surgery. If you went this way I would see if you could get the professor to do your surgery. I also found out that there are a couple options for financing. Medical financing is suppose to be different then any other financing, the OMS office will let you know which ones are available in your area.
I gave this information because I had to go to soooo many websites and blogs to find those 3 financing options.