Re: Hi All....Can Someone Calm my Fears??

[Guest guest]

Hello, you are a little further along than I am. Right now I'm

stressing about choosing the right surgeon and trying to get

insurance to pre-approve the surgery. I'm just wondering, what

insurance company are you under and how did you know you chose the

right surgeon? I have BCBS of MA and they have denied my first

submission for coverage. How long did it take you (and how did you

do it) to get the surgery covered?

-nate

[Guest guest]

Hello, you are a little further along than I am. Right now I'm

stressing about choosing the right surgeon and trying to get

insurance to pre-approve the surgery. I'm just wondering, what

insurance company are you under and how did you know you chose the

right surgeon? I have BCBS of MA and they have denied my first

submission for coverage. How long did it take you (and how did you

do it) to get the surgery covered?

-nate

[Guest guest]

Nate,

It wasn't very easy to get my procedure covered. I was suppose to

have both upper and lower jaw surgery, but my insurance company,

Aetna, denied the lower coverage and upper coverage due to the fact I

have TMJ and the treatment of TMJ is seen as experimental at best.

So, we processed the appeal with the notice that I have arthritis and

to stop the progression/degredation of my joints the TMJ treatment

was necessary and as a result, now my teeth do not meet...so

therefore the surgery is necessary. My surgeon wanted to do a

procedure that required bone grafting, but Aetna wouldn't have it.

Basically, Aetna denied my coverage 3 times...the last time in their

last letter of Oct 2004, they denied coverage for my orthodontic

treatment, too, which they had been covering since Oct 2003. I made a

rush decision, and with the approval of my surgeon, called Aetna and

got them to cover a very small procedure they had agreed to cover if

we appealed again and asked for it. Instead of the 3 piece upper and

one piece lower jaw surgery...I am getting only a one piece lower;

the only one that Aetna will cover. The sliding genio I am having to

pay for myself. I wish I could tell you something positive about it,

but it was honestly a nightmare Nate...to get Aetna to cover

something...anything. The Dr's office had been fighting since Nov

2003 to get coverage...I joined the battle in March 2004...and I

finally got the small procedure covered on Nov 1st 2004...and my

surgery is Dec 15th. Talk about last minute!

About the surgeon...my progression through Drs has been very chain-

like. I saw my general dentist who was the first put a splint on my

teeth. When my teeth stopped meeting together, he sent me to a TMJ

specialist who taught him (my dentist) how to make the splint. The

specialist worked on my splint for a yr...gave me arthritis

treatments...and once somewhat stabilized he sent me to an

orthodontist to see where we needed to go from there. The

orthodontist determined that there was no way to get my teeth to meet

without surgery...and his younger brother is a plastic surgeon with a

specialty in face reconstruction and orthognathic surgery. He is not

an Oral Surgeon. I trust my Drs, both brothers, but am still a little

apprehensive about this whole situation. I know my surgeon does good

work...he was one of the surgeons on the team in Dallas that

separated the conjoined twins from Egypt. If he can help kids like

the twins...surely he can help someone with such a minor problems

like me.

Does this help? I hope I haven't totally killed your spirits...you

have to maintain some positive outlook on this whole situation and

remember that you will one day feel better again about yourself in

order to keep going.

>

> Hello, you are a little further along than I am. Right now I'm

> stressing about choosing the right surgeon and trying to get

> insurance to pre-approve the surgery. I'm just wondering, what

> insurance company are you under and how did you know you chose the

> right surgeon? I have BCBS of MA and they have denied my first

> submission for coverage. How long did it take you (and how did you

> do it) to get the surgery covered?

>

> -nate

[Guest guest]

Nate,

It wasn't very easy to get my procedure covered. I was suppose to

have both upper and lower jaw surgery, but my insurance company,

Aetna, denied the lower coverage and upper coverage due to the fact I

have TMJ and the treatment of TMJ is seen as experimental at best.

So, we processed the appeal with the notice that I have arthritis and

to stop the progression/degredation of my joints the TMJ treatment

was necessary and as a result, now my teeth do not meet...so

therefore the surgery is necessary. My surgeon wanted to do a

procedure that required bone grafting, but Aetna wouldn't have it.

Basically, Aetna denied my coverage 3 times...the last time in their

last letter of Oct 2004, they denied coverage for my orthodontic

treatment, too, which they had been covering since Oct 2003. I made a

rush decision, and with the approval of my surgeon, called Aetna and

got them to cover a very small procedure they had agreed to cover if

we appealed again and asked for it. Instead of the 3 piece upper and

one piece lower jaw surgery...I am getting only a one piece lower;

the only one that Aetna will cover. The sliding genio I am having to

pay for myself. I wish I could tell you something positive about it,

but it was honestly a nightmare Nate...to get Aetna to cover

something...anything. The Dr's office had been fighting since Nov

2003 to get coverage...I joined the battle in March 2004...and I

finally got the small procedure covered on Nov 1st 2004...and my

surgery is Dec 15th. Talk about last minute!

About the surgeon...my progression through Drs has been very chain-

like. I saw my general dentist who was the first put a splint on my

teeth. When my teeth stopped meeting together, he sent me to a TMJ

specialist who taught him (my dentist) how to make the splint. The

specialist worked on my splint for a yr...gave me arthritis

treatments...and once somewhat stabilized he sent me to an

orthodontist to see where we needed to go from there. The

orthodontist determined that there was no way to get my teeth to meet

without surgery...and his younger brother is a plastic surgeon with a

specialty in face reconstruction and orthognathic surgery. He is not

an Oral Surgeon. I trust my Drs, both brothers, but am still a little

apprehensive about this whole situation. I know my surgeon does good

work...he was one of the surgeons on the team in Dallas that

separated the conjoined twins from Egypt. If he can help kids like

the twins...surely he can help someone with such a minor problems

like me.

Does this help? I hope I haven't totally killed your spirits...you

have to maintain some positive outlook on this whole situation and

remember that you will one day feel better again about yourself in

order to keep going.

>

> Hello, you are a little further along than I am. Right now I'm

> stressing about choosing the right surgeon and trying to get

> insurance to pre-approve the surgery. I'm just wondering, what

> insurance company are you under and how did you know you chose the

> right surgeon? I have BCBS of MA and they have denied my first

> submission for coverage. How long did it take you (and how did you

> do it) to get the surgery covered?

>

> -nate

[Guest guest]

Well, I can tell you that I had significant help with joint pain.

But, and you may not like this one so much, you may need a

specialist in TMJ treatment. I believe that there are joints

suffering from arthritic deterioration that need very specialized

help.

My surgeon, who is wonderful, said that the jaw surgery could make

TMJ problems better, or it could make them worse.

perhaps you need a surgeon who specialises in treating these TMJ

troubles.

There are docs who do so, and you may have some of the best. Just

ask a lot of questions. I do not doubt your pain now, and it is

possible that you will have it later. But before you go into

surgery, ask your docs what they think, and how they propose to help

you, post-op.

C.

>

> Hi, I am new to this group and joined today after finding it when

> doing a Google search. I felt a little calmer after reading some

of

> the threads and conversations going on between the other members.

>

> I am 23 years old and scheduled to have surgery Dec 15th. I have

TMJ

> and arthritis in both joints. Significant breakdown of the joint

on

> my right side. I have been in a splint for over 3 years and have

> gone from Dr to Dr. I take arthritis medication and muscle

relaxers

> everyday...sometimes I have to chase these with a pain

> medication...Butabitol..to make my migraines go away. I have a

> significant gap between my upper and lower teeth...I haven't been

> able to chew food without a splint for 2 years because my teeth

don't

> touch. My surgery is going to be a one piece upper lefort

1...with

> sliding genioplasty to fix lip tension. I am worried that I am not

> doing the right thing...however, the Drs and I see no other way

out

> of this splint. I have a great surgeon...and I trust him...I am

just

> having some doubts. After battling with insurance for a

year...I'm

> really just exhausted from all of this emotional upheaval.

>

> I know there are several of you that have had this procedure

done.

> If there are any words of encouragement I would greatly appreciate

> it. Did any of you go into the surgery still in pain...and come

out

> still hurting? I am told by my Dr that what I feel now...I will

> still feel after and I will still need all of my meds. Any

> experience would be helpful...

>

>

[Guest guest]

Well, I can tell you that I had significant help with joint pain.

But, and you may not like this one so much, you may need a

specialist in TMJ treatment. I believe that there are joints

suffering from arthritic deterioration that need very specialized

help.

My surgeon, who is wonderful, said that the jaw surgery could make

TMJ problems better, or it could make them worse.

perhaps you need a surgeon who specialises in treating these TMJ

troubles.

There are docs who do so, and you may have some of the best. Just

ask a lot of questions. I do not doubt your pain now, and it is

possible that you will have it later. But before you go into

surgery, ask your docs what they think, and how they propose to help

you, post-op.

C.

>

> Hi, I am new to this group and joined today after finding it when

> doing a Google search. I felt a little calmer after reading some

of

> the threads and conversations going on between the other members.

>

> I am 23 years old and scheduled to have surgery Dec 15th. I have

TMJ

> and arthritis in both joints. Significant breakdown of the joint

on

> my right side. I have been in a splint for over 3 years and have

> gone from Dr to Dr. I take arthritis medication and muscle

relaxers

> everyday...sometimes I have to chase these with a pain

> medication...Butabitol..to make my migraines go away. I have a

> significant gap between my upper and lower teeth...I haven't been

> able to chew food without a splint for 2 years because my teeth

don't

> touch. My surgery is going to be a one piece upper lefort

1...with

> sliding genioplasty to fix lip tension. I am worried that I am not

> doing the right thing...however, the Drs and I see no other way

out

> of this splint. I have a great surgeon...and I trust him...I am

just

> having some doubts. After battling with insurance for a

year...I'm

> really just exhausted from all of this emotional upheaval.

>

> I know there are several of you that have had this procedure

done.

> If there are any words of encouragement I would greatly appreciate

> it. Did any of you go into the surgery still in pain...and come

out

> still hurting? I am told by my Dr that what I feel now...I will

> still feel after and I will still need all of my meds. Any

> experience would be helpful...

>

>

[Guest guest]

Nate,

I know you weren't addressing your question to me, but I have BCBS

of TN. I was denied for upper and lower jaw surgery, too. I went

through the grievance process as outline in their evidence of

coverage. Orthognatic surgery is an exclusion of my policy. My OS

told me to give it up since it was an exclusion, they would not

pay. However, in the third step of the appeal process, I appealed

quoting the evidence of coverage stating they would pay if it

is " surgery and services to correct congenital malformations which

are outside the normal and individual variation and have resulted in

significant functional impairment. " In my initial grievance letter,

I listed all of the pain and where, headaches, pain in jaws, trouble

chewing food. Clenching... anything you can think of that causes you

trouble.

It worked for me, but it was a fight that I was prepared to go all

the way with. It might be worth a try.

Pam

>

> Hello, you are a little further along than I am. Right now I'm

> stressing about choosing the right surgeon and trying to get

> insurance to pre-approve the surgery. I'm just wondering, what

> insurance company are you under and how did you know you chose the

> right surgeon? I have BCBS of MA and they have denied my first

> submission for coverage. How long did it take you (and how did

you

> do it) to get the surgery covered?

>

> -nate

[Guest guest]

Nate,

I know you weren't addressing your question to me, but I have BCBS

of TN. I was denied for upper and lower jaw surgery, too. I went

through the grievance process as outline in their evidence of

coverage. Orthognatic surgery is an exclusion of my policy. My OS

told me to give it up since it was an exclusion, they would not

pay. However, in the third step of the appeal process, I appealed

quoting the evidence of coverage stating they would pay if it

is " surgery and services to correct congenital malformations which

are outside the normal and individual variation and have resulted in

significant functional impairment. " In my initial grievance letter,

I listed all of the pain and where, headaches, pain in jaws, trouble

chewing food. Clenching... anything you can think of that causes you

trouble.

It worked for me, but it was a fight that I was prepared to go all

the way with. It might be worth a try.

Pam

>

> Hello, you are a little further along than I am. Right now I'm

> stressing about choosing the right surgeon and trying to get

> insurance to pre-approve the surgery. I'm just wondering, what

> insurance company are you under and how did you know you chose the

> right surgeon? I have BCBS of MA and they have denied my first

> submission for coverage. How long did it take you (and how did

you

> do it) to get the surgery covered?

>

> -nate

[Guest guest]

C,

I appreciate the advice...and I have a TMJ specialist. But even he

doesn't know for sure what will happen. It seems as though when I

started TMJ treatment with the splint and everything, I had a lot of

pain and ear problems, but even now I have those problems

still...with some additional difficulties. The surgery is to correct

my bite...my joints have gone back into place, but my ear tube still

gets pinched shut, the headaches are still there, and I still ache

everywhere. I have an appt to talk with my specialist about the

pain, but we have talked before about this problem...and I am

fearing the same results from the conversation (i.e., your pain will

still be there after the surgery).

I did appreciate hearing that your pain decreased. I hope I may be

so lucky.

M

> >

> > Hi, I am new to this group and joined today after finding it

when

> > doing a Google search. I felt a little calmer after reading

some

> of

> > the threads and conversations going on between the other members.

> >

> > I am 23 years old and scheduled to have surgery Dec 15th. I

have

> TMJ

> > and arthritis in both joints. Significant breakdown of the

joint

> on

> > my right side. I have been in a splint for over 3 years and

have

> > gone from Dr to Dr. I take arthritis medication and muscle

> relaxers

> > everyday...sometimes I have to chase these with a pain

> > medication...Butabitol..to make my migraines go away. I have a

> > significant gap between my upper and lower teeth...I haven't

been

> > able to chew food without a splint for 2 years because my teeth

> don't

> > touch. My surgery is going to be a one piece upper lefort

> 1...with

> > sliding genioplasty to fix lip tension. I am worried that I am

not

> > doing the right thing...however, the Drs and I see no other way

> out

> > of this splint. I have a great surgeon...and I trust him...I am

> just

> > having some doubts. After battling with insurance for a

> year...I'm

> > really just exhausted from all of this emotional upheaval.

> >

> > I know there are several of you that have had this procedure

> done.

> > If there are any words of encouragement I would greatly

appreciate

> > it. Did any of you go into the surgery still in pain...and come

> out

> > still hurting? I am told by my Dr that what I feel now...I will

> > still feel after and I will still need all of my meds. Any

> > experience would be helpful...

> >

> >

[Guest guest]

C,

I appreciate the advice...and I have a TMJ specialist. But even he

doesn't know for sure what will happen. It seems as though when I

started TMJ treatment with the splint and everything, I had a lot of

pain and ear problems, but even now I have those problems

still...with some additional difficulties. The surgery is to correct

my bite...my joints have gone back into place, but my ear tube still

gets pinched shut, the headaches are still there, and I still ache

everywhere. I have an appt to talk with my specialist about the

pain, but we have talked before about this problem...and I am

fearing the same results from the conversation (i.e., your pain will

still be there after the surgery).

I did appreciate hearing that your pain decreased. I hope I may be

so lucky.

M

> >

> > Hi, I am new to this group and joined today after finding it

when

> > doing a Google search. I felt a little calmer after reading

some

> of

> > the threads and conversations going on between the other members.

> >

> > I am 23 years old and scheduled to have surgery Dec 15th. I

have

> TMJ

> > and arthritis in both joints. Significant breakdown of the

joint

> on

> > my right side. I have been in a splint for over 3 years and

have

> > gone from Dr to Dr. I take arthritis medication and muscle

> relaxers

> > everyday...sometimes I have to chase these with a pain

> > medication...Butabitol..to make my migraines go away. I have a

> > significant gap between my upper and lower teeth...I haven't

been

> > able to chew food without a splint for 2 years because my teeth

> don't

> > touch. My surgery is going to be a one piece upper lefort

> 1...with

> > sliding genioplasty to fix lip tension. I am worried that I am

not

> > doing the right thing...however, the Drs and I see no other way

> out

> > of this splint. I have a great surgeon...and I trust him...I am

> just

> > having some doubts. After battling with insurance for a

> year...I'm

> > really just exhausted from all of this emotional upheaval.

> >

> > I know there are several of you that have had this procedure

> done.

> > If there are any words of encouragement I would greatly

appreciate

> > it. Did any of you go into the surgery still in pain...and come

> out

> > still hurting? I am told by my Dr that what I feel now...I will

> > still feel after and I will still need all of my meds. Any

> > experience would be helpful...

> >

> >