RE: Re: Confused

[Guest guest]

My orthodontist wanted to bill medical as he was preparing me for medical

surgery. Since medical would pay at 80%, I was hopeful. Medical denied the

claim, but not until the claim made it to a third review. Part of me is

tempted to appeal the decision, but I don't know that I have the energy.

I do plan to answer the questionnaire honestly. What I meant was which of my

symptoms is considered TMD? The questions are written in such a way that I'm

not sure how they would rule.

I have a limited opening (two finger widths), open front bite that causes

problems eating, frequent headaches, grinding noise on my right jaw when

eating, worn teeth that no longer touch or connect. I wore an NTI at night

for two years to help with my headaches. I think it was this device that

guided my lower jaw out of alignment. I can't get the dentist who fit me for

the device to agree, but I have found information on the internet suggesting

an open bite could occur. I've been advised by my OS to discontinue this

device.

The last year and a half (when my jaw really began to bother me), I started

coughing frequently. My doctor told me I had acid reflux and put me on

Prilosec. I'm now wondering if this isn't due to my recessed lower jaw. My

husband said I've also started snoring.

I'm new to this whole process, so am trying to piece things together. I

appreciate your advice.

_____

From: ceast36532 [mailto:no_reply ]

Sent: Thursday, February 24, 2005 4:51 PM

To: orthognathicsurgerysupport

Subject: Re:

Confused

Usually, dental ins. covers the ortho -- at least up to its cap,

which is usually a lifetime cap.

Usually MEDICAL insurance covers the surgery, on the grounds that it

is necessary repair of a congenital, skeletal defect. Be careful of

the TMJ argument, as some policies specifically exclude surgical

treatment of TMJD.

I would suggest that you be purely truthful with that questionnaire.

If you have headaches, say so. If you have grinding and are wearing

tooth surfaces, or cracking your teeth, say so. If you have popping

and/or clicking in your jaws, or if your jaw locks, say so. If you

have trouble eating (which sometimes leads to digestive disorders,)

say so.

> I understand your concerns. I'm new to this board...my first

posting.

>

> I first consulted an orthodontist Nov. 2004. He referred me to an

> orthognathic surgeon. I have blue cross and they paid 80% of the

surgeon

> visit. However, they've denied my $1,200 so far in orthodontic

visits (not

> including braces). They're now billing dental for the $1,200. I'm

hoping for

> a 50% benefit.

>

> The surgeon's office sent me a six-page questionnaire to help out

with

> insurance on the surgery. They suggested I submit the questionnaire

soon as

> it takes three months or more for insurance review, etc. I plan to

answer

> the questions truthfully, but am not sure what they're looking for

to say

> it's TMJ-related.

>

> Money was a huge thing for me..and very stressful. I talked with my

husband

> and decided I was going ahead with braces and surgery on my own. If

> insurance picks up part of the cost, great. So, I took out a line

of credit

> on my home. This way I know the money is there if I need it and I

can write

> the interest off on my taxes.

>

> I'm getting braces March 14 and at this point will have lower jaw

surgery

> (possibly upper jaw, too) in about 9 - 12 months.

>

> Good luck!