Friday, July 23, 2010

The Ultimate Soccer Mom!!!

Well, last week was a fun and crazy week. We hosted two soccer coaches from England in our home while we had the Challenger British Soccer Camp in town. The guys were great and it was fun to have them around and fretting over them all week. They eat ALOT of food. I guess that's what I have to expect when my kids become teenagers-that and all their friends. LOL!  I really loved the accent. I felt like every time they told me how wonderful my food was that I was being complimented by Chef Ramsey himself! :)

They left on Sunday and I was much more depressed about it than I realized. My husband was as well. He never had any siblings and he really bonded with one of the guys. We both cried after they left. :( I RARELY take pics with my braces on so this is a treat. I was actually whining about it and Simon, the one with blonde hair, said let's all make mad faces to hide your braces. Of course my face didn't turn out so mad! Showing my braces, gums and all in full American Pride....

It was a nice break from my reality of "THE JAWS". I got my denial letter in the mail on Saturday. I wasn't really surprised. Insurance companies are so rich it isn't funny. The thing I was most peeved about was their reason (if you can call it that) which really hopscotched around everything. It stated:

"Member has submitted appeal of the denial for orthognathic surgery, and included information from her birth.  The medical records identify bruising and skin changes about the face; however, these physical findings would not have occurred as a result of a birth defect per se.  Therefore, please uphold the contractual denial for this surgery request."

Ugh...I was so fuming! I mean, first off, I wasn't saying it was a birth defect...I stated it was an accidental injury that resulted in this. Also, the medical records didn't say "skin changes". It was very clear in saying there was hemorrhaging, bruising and severe swelling. I also included a JAMA article talking about birth injuries and the jaw and mentioned all of the medical issues I've had SINCE BIRTH. They didn't even look at this stuff. So, instead of causing myself a panic attack I have said forget Blue Cross and Blue Shield and have issued a complaint with the State of Missouri Department of Insurance. They are an impartial party and will review all documents and make their decision based on ALL evidence. It may take them awhile so I'm sure I'll just go forward, pay the surgery as planned, and wait for good news from the state! Do you know of anyone who has filed this type of complaint and how it worked out for them????

My records appointment is Monday! I'm tempted to just call my Oral Surgeon to go ahead and schedule my appointment with them but I have a feeling they won't do that. I've had issues with clenching my teeth at night and it gets worse with hormone changes and stress. I've noticed it more lately now that things are getting closer to D-Day. I was prescribed muscle relaxers (last year!) that I would take a couple evenings a month to help but I'm out and the Oral Surgeon won't prescribe any more. Is that normal? It's not like I'm addicted. I've had the same bottle for over 8 months! 

I also plan on calling my husband's company to see how much more money we have in our medical spending account. I'm thinking it's around $1,600 so that'll be good to put down on the surgery. One lady posted that her company helped pay her surgery that wasn't covered by insurance, but I don't know how comfortable I would feel asking my husband's company if they had something in place like that...I'm not the one that works there..you know?? 

Well, I better get to my phone calls. I DO plan on posting "mouth pics" now that things are pretty much where they're supposed to be. I just get anxious. I don't even post pics of me in braces on Facebook---I don't even kiss my husband on the mouth! How pathetic am I??? My poor, poor husband. So thankful he's understanding. I'm sure he'll be expecting lots of kisses once this is all over with...

XOXOXOX :)

2 comments:

Anonymous said...

Sorry to hear about the denial girlie. Insurance companies suck! Hope the appeal with the state goes well. Have you had your impressions taken yet? I get mine taken next week. Let's get this show on the road!! I am ready to get this surgery behind me! :) Mandy Jaw Surgery

E Hest said...

Too Funny! How'd I know you'd sign your name that way? lol! I had impressions yesterday. I plan on posting the pics they took soon. It's amazing to see how much braces can move teeth in a year. We are sooo close in this process! You're getting upper and lower done right? Are you doing the chin???