Tuesday, May 25, 2010

The Good, The Bad, The Ugly

The Good: 
I'm warning you...I'm on my pity pot today so in my mind I don't feel like there's much good going on right now.  I am going to the ortho today. They put spacers in my two bottom back molars last week and today they will remove those (that's good) and redo all of my bottom braces to include my two very back molars.  These two molars were turned inward a little so they want to fix that. At least when things happen I feel "progress" and that we're moving right along. I'll ask my ortho when he anticipates surgery date to be. I asked him in January and he said late Aug, early Sept. so we'll see if he's still keeping that date. Oh, there is ONE really good thing...we should have our car paid off the end of June! We have been working really hard at getting our debt paid off before this surgery and other than our house, the car is the last thing. Then, we can start saving up for this surgery!!!

The Bad:
So, now to the bad...I received my denial letter from insurance on Wednesday.  I had a feeling they were going to deny it but I was willing to file an appeal due to the fact of medical necessity. I have been ordering and organizing all of my medical records ready to fight the appeal...then I read the letter which states, "Because this denial is a result of a specific benefit limitation under your plan, this appeal will not be reviewed for medical necessity at any level of appeal REGARDLESS OF YOUR HEALTH CONDITION. " So, I was pretty bummed. I am going to email an attorney that I used to work for to see if there is anything else we can do, but if not...we're totally stuck with the bill. It just angers me how insurance will pay for something like lap-band surgery, but not this when it's something I cannot change or manage on my own w/out surgery. 

I've been trying to work out at Curves and they had this Chiropractor there doing this computerized spinal examination where it checks your muscle contractions. It was very interesting to see where all of my muscle tension was held. The pic on the left is a "normal" person and the one on the right was me. Notice how much tension was in the left side up high by my jaw?? Crazy....That's the side that has the cant that the oral surgeon says I compensate for. I really hope after this surgery this tension can be relieved.

The Ugly:
So, I told you I'm on my pity pot....I feel really ugly right now. I've had the braces for 9 months now. I really don't mind them,but since it's adjusting my mouth for this future surgery everything is screwed up. I feel like I just "hang" there w/ my mouth open all the time--With no teeth touching. I'm always the last one to finish my food and have to use my hand to cover my mouth the entire time.  Since my jaw is relaxing and moving back in it's place I have less and less of a jaw and chin and I feel like I have a harder time breathing. As most people LOSE weight with braces I have actually GAINED over 7 lbs. That's a lot for someone who's only 5'2'". I am totally an emotional eater and I think this whole situation has taken a bigger toll on me than I want to believe...so I turn to food. :( Soft, easy food like cupcakes, brownies and noodles and french fries... very sad--but TRUE. I've been working so hard on our financial situation and seeing lots of progress.  I need to focus just as much on my spiritual and physical health too.

5 comments:

Anonymous said...

Oh no- I am so sorry to hear about your insurance. Hopefully your attorney will give you some good news about a loophole. I can't imagine having to pay everything out of pocket. My total out of pocket is almost $14,000 and that is with my insurance covering it. UGGGGG! I got an approval letter but there is also a blurb in the letter stating that this is not a confirmation that they will in fact pay. So who the heck knows, they mind end up paying nothing. This is certainly putting a financial strain on our family. Frustrating.

And, I totally know how you feel about feeling "ugly" I look in the mirror and want to puke somedays. I often wonder how my husband can put up with it! :) I could barely close my mouth without braces and now they take up so much space that forget closing my mouth. I eat so slow and have a napkin over my mouth the entire time. Lovely.

Email me anytime you need to vent as it sounds like our stories are very similar.

Take care and know you are not alone!

Mandy

E Hest said...

Mandy, you sound so similiar to me! What's your email? I wanted to ask you some questions regarding your insurance.

Thanks, E

Anonymous said...

Hey there- it is mandyjoshnapier@hotmail.com

Anonymous said...

I can so relate - I'm hoping for Surgery in Nov/Dec or around there. I feel so unattractive right now. Because the braces are moving my teeth back to fit my jaw (not to fit together) I have a terrible cross-bite right now and it seems I have a headache all the time - mostly by my right ear. I can't open my mouth all the way, and it's hard for people to understand what I'm going through. On the other hand, it feels good to have a plan and knowing that I am getting closer to the finish line. I wish you all the best in your journey!

stephanie said...

Hi! I don't know what company you get your benefits through, but I had the same thing happen to me - it was a contract exclusion denial, rather than a medical necessity denial. I was able to appeal to my school district (I'm a teacher) and they paid for it once I proved to them how necessary it really was. Maybe you could contact your benefits coordinator and ask if this is a possibilty? If so, I am totally willing to email you my appeal letters from myself, my orthodontist, and my surgeon, which really helped my case get moved forward. They're also on my blog.

Good luck!
Stephanie