Insurance and Out-of-Pocket Time Line

This is Long! Sorry! 2011: The dentist I had seen my entire life had recommended I fix my jaws. I wore braces when I was a teenager and for whatever reason I ended up not doing the surgery. My parents and I have conflicting recollection of why I didn't have it. I remember that the insurance was denying us and I'd been in braces 5 years when I finally said forget it. They remember that I wanted my braces off to look pretty at the Prom. Either way, it wasn't done. 18 years later... The life long dentist retired and I went to a new dentist in Dallas. On my first visit he said the 2 teeth I was using looked terrible. I told him about the headaches and he referred me to a Maxillofacial Surgeon. At the time I had United Healthcare. The doctor he referred me to was not in Network. I chose another doctor I found online. I went to a consultation and he reconfirmed I need double jaw surgery. They requested payment from my insurance. I was denied. No payment plans. 2012: My good friend referred me to a doctor who treated her sister. I went to a consultation and he suggested I get a sleep study. I went to the sleep study. The results were that I do not have sleep apnea, but I do have a restricted airway. This restriction was causing 8 arousals per hour. In sleep apnea, the person stops breathing and in an arousal the muscles jerk the person awake prior to losing their breath. Basically, I wake up 60 times a night. The Sleep Doctor told me that a person can ‘get’ sleep apnea. We took this information and combined with the Acid Reflux, headaches and chewing problems wrote a second request for coverage. Denied. No payment plans. 2013: I changed jobs and the new job did not offer insurance. I applied for BCBS and was denied due to pre-existing conditions. I applied for Cigna and was denied for the same reason. I applied for BCBS Texas Health Pool for people with pre-existing conditions and they accepted me. My monthly premium was $400 and they covered nothing. I met a dental nurse and told her my situation. She referred me to a Doctor in Dallas who she believed could get me a cheap surgery. He was a teacher at Baylor specializing in Jaw surgery. Baylor had a teaching program where the program covers the surgery. I booked a consultation. When I met the doctor he told me that Baylor no longer sponsored those surgeries but I would have been a good candidate. He now runs a private practice and still maintains privileges at Baylor. He reviewed my case and asked if I’d had an MRI. After I told him no, he said, “How did these other doctors diagnose you if they hadn’t seen an MRI?” He told me that the clicking was a TMJ issue. If I had something wrong with my TMJ then that would have to be fixed. He said that if you do orthognathic surgery to correct an open bite and there is a problem with the TMJ, then the bite could return to its previous state after surgery! I booked an MRI. It was $500 since my insurance covered nothing. The MRI results showed that I have dislocated both discs in my TMJ which helps the jaws rotate smoothly. Instead they are scraping against my skull. This doctor told me that I should do the surgery and that it would be a long process and to be prepared. His staff said I could do a payment plan. He laughed when I showed him what the other doctors wanted to charge me for the surgery. He said he would do the top & bottom jaw, the palate and both TMJ replacements for $20,000 less then the others charged for just the double Jaw Surgery. He also offered me a payment plan since I was going to battle this out-of-pocket. April 2013: My Orthodontist reviewed my case and spoke with my surgeon. I had enough recession on my top gums that it could intervene with a surgical cut. They sent me to a Periodontist for gum surgery. I booked the surgery. I first went to my Dentist to remove a bridge I’ve had since childhood. There was a deciduous tooth but not a permanent tooth. They removed it and placed a bridge there. My Dentist broke it off and sent me back to the orthodontist to get my bottom braces put on. May 2013: I went in for gum surgery. It was painful. I was awake during the surgery but didn’t feel anything. I felt it the next day and the 10 days that followed. It was $2500 out-of-pocket since Health Pool doesn’t pay for anything. June 2013: I drop Health Pool. It’s worthless. July 2013: I get my top braces. October 1 2013: Open enrollment begins and the website is non-functional. After 30 days of repetitive efforts I am able to get into the site and fill out the enrollment application. I am given 11 options of Insurance to chose from and the prices range from $265-400. So much for affordable care. My boyfriend and I discuss a quickie courthouse marriage so I can join his insurance policy. That conversation quickly diminished and I have now narrowed my choices down to 2 Cigna policies. I am quite certain that I will not get any help for the surgery. At this point I am trying to save myself from a $30,000 hospital bill. The surgery and hospital stay are separate and I’ve heard that hospital bills can bankrupt people and really drag them through the financial mud for years. I also went to visit my Dentist for a cleaning and was surprised to find he retired! All the staff was gone too, it was kind of weird. I didn't get a note or anything. Ha! This ordeal is taking so long that I've seen two Dentists retire! I hope my Surgeon doesn't retire too. He's pretty young though, so I don't think I have to worry.

Reasons

I’d been having headaches, stress and pain in my jaws, difficulty chewing, popping and crunching noises in my ear when I talk, sing or eat. If I get hungry I’ll start sneezing and eventually throw up. I thought I was hypoglycemic but my doctor said it was acid being overproduced in my stomach due to digestion problems from not chewing my food. I have never been able to properly chew food. I chewed with the right side teeth for most of my adult life. The left side doesn't rotate well and at some point I just didn't really use that side. When I got braces, they removed a bridge I've had since I was a teen. Now there is just a blank space where the bridge was and I am toothless! That was my go-to side for chewing and without the tooth I'm forced to chew on the left. It feels wrong. I don't really have an issue cosmetically. My chin is definitely short and it makes my neck/jowels (jowels is a horrible word) scrunch up. This is not why anyone should do the surgery in my opinion. I have a lisp that I've controlled over the years. My tongue thrust is pretty bad. TMJ is the painful stuff. The discs that rotate my jaw bones have moved out of their spot. That kind of sums up why I want to go through all this to close my teeth! Here is my X-Ray. You can see where the bridge was , but it's gone now.

Set Up

I'm getting this blog set up for my upcoming jaw surgery. It's now November 2013 and I'm having surgery in March 2014. I have an open bite and both TMJ discs need replacement. I'll go into more detail a bit later about the specifics. Right now I want to figure out what needs to be on this blog. A couple of things I've been looking for in other blogs are tips to stay healthy during the recovery process and people who are having trouble with insurance. Those are my big concerns. I read about a girl who was juicing Spaghettios. That's gross. I'm sure I would need a second surgery if I did that. I am not a health freak but I diet and exercise regularly and I want to make recovery as pleasant as possible. I love to eat! I want to make delicious juices and soups and I hope someone else can enjoy the recipes. Insurance for me has been a pain. From the very start I have had trouble and I'll also talk about that in another post. For now, here are some photos of my teeth.