first time poster

October 9, 2004

Hi, I have been lurking on this sight for a few months but this is

my first post. My 17 year old daughter just had upper jaw surgery

on the 6th and I wanted to share our story.

It has been a long road for us. She got her braces on in 8th

grade. We knew from the beginning that she would probably be having

this surgery. Her older brother had the same surgery done for an

open bite four years ago when he was 16. We were preparing for her

surgery to be done june of 2002. A couple of weeks before her

scheduled surgery she was critically injured in a car accident and

suffered a traumatic brain injury. She was airlifted to the

hospital in critical condition on a venilator and in a coma for a

couple of days. She suffered short term memory problems and spent

the remainder of the summer doing outpatient physical, speech and

educational therapy. So, obviously the surgery was cancelled so

that she could recover from her accident. The surgeons office

notified insurance that the surgery was on hold until Christmas time

when she would be recovered and would have time off from school to

recover from surgery.

December came and we were all ready for the surgery, including the

preop physical. The surgeons office checked with insurance to make

sure that everything was set and they said they didn't have a

preapproval for the surgery. The surgeons office faxed them a copy

of the preapproval and their answer was " we don't know why you got

this but you shouldn't have, we never approved the surgery. " The

were unable however to produce a denial letter. The surgeons

office, my husbands company's hr dept etc fought it and we got no

where. What we believe happened was this. The dummy date that was

used when the surgery information was submitted happened to be the

same date that she was injured in her car accident. When the

hospital bills started to come in with that date of service they

thought it was related to the surgery and took the preapproval out

of the system. When they were sent the copy of the approval and

investigated it they saw that they had paid out more than $50,000

from her car accident and didn't want to pay anymore so refused to

come up with an approval. Even by appealing it would put us into a

new year with a whole new deductibe and out of pocket to meet. (the

surgery would not have cost us anything due to the out of pocket

being met after the accident). Also our benefits were changing with

higher out of pocket amounts. So even if they lost the appeal they

would have to pay less by stalling until after the first of the

year. We were in the process of appealing when my husband took a

new job that brought us to a new state and we had new insurance.

So we had to start over with a new orthodontist and another fee of

over $4,000. We saw a surgeon and started the approval process over

again with the new surgeon and new insurance. I was not really that

crazy about the surgeon but he was the only one in our area that we

could use with our insurance. Everytime I brought up a date I

wanted to do the surgery so that she would be able to have it done

over a school holiday and not have to miss alot of school he said

no, that was time he was spending with his family.

It took from Oct. of 2003 until around april of 2004 before I got an

answer back from insurance and we got approved. We went back to the

surgeon and tried to schedule a date for summer. His answer: " I

have three family weddings this summer and don't have time. " I

pushed for a date over the summer and they called me back in a

couple of days and said that the assistant he used comes from out of

town and was unavailable until Oct. but if I wanted to find another

surgeon they would understand. So I did. By this time there were

other surgeons I could use. So we switched and I found one I like

much better that could do it over the summer. We were tenative for

July 7 then found out that the approval that we got through the

original surgeons office was for lower jaw and she was having upper

done. they had submitted it wrong. So the new surgeon had to

resubmit everything and we had to wait until we got the new approval

which was after the date we had planned so it could not be done over

the summer. Next date for a school vacation was Oct 6 with the

following week of school off for fall break which would cut down on

the amount of time out of school. So back to the orthodontist for

more presurgical records. yet again.

But finally the date came and she was able to have the surgery.

The surgery was done early Oct. 6th. She spent the night in a step

down icu. I was pleasantly surprised at the amount of swelling.

When my son had his surgery his face was HUGE!! He had upper and

genio and four wisdom teeth removed. She did not have the genio

done and only had one upper wisdom tooth to remove so I imagine this

was the difference in swelling.

We came home the next day about lunch time. She was not wired shut

but has very strong rubber bands keeping her bite tightly closed.

She cannot take the rubber bands off , they have to stay on. This

is one difference between my son's surgery and hers. His surgeon

used rubber bands that he was supposed to remove to eat and brush

then put them back on. It allowed him more eating possibilities as

she is really limited to anything liquid. He was able to get things

like pudding into his mouth using a spoon.

Her swelling seems to be worse today. We are back to using the ice

packs. She is very miserable with not being able to breathe. I

think she is doing great and looks great for being so early after

the surgery, but she is very cranky and seems to take it out on me.

I guess that's what moms are for.

Well, I have written more than enough for now. Will post more on

the actual surgery and recovery process later. Thanks for listening.

Laurie

October 9, 2004