We're under 2 months now!!!
Today, I feel like I wish the surgery were tomorrow - I just want it over with at this point! I found a new blog of somebody who had the surgery.
I find a lot of people who have an underbite and get double jaw surgery, but I read less about people with an overbite who get the surgery. I wonder if having an underbite is more difficult, or if it makes you want the surgery more for cosmetic reasons? I'm interested to read about someone who had an overbite & hear what they have to say about breathing after the surgery - I've been told mine will improve, so I'm just curious. Anyway, here's her site:
http://survivingjawsurgery.blogspot.com/
Friday, June 24, 2011
Wednesday, June 22, 2011
Last 2 Ortho Appointments Before the Surgery
Today I scheduled my last two orthodontic appointments before the surgery. One is a month before to get everything set up, and then one is the morning before the surgery to have "hooks" put in - whatever that means, I'm trying not to think about it.
It's weird to have that brought in, it's sort of making it a little more real... the surgery is coming - in 2 months. Which probably feels like a long time on that side of the blog, but I'm here to tell you that on this side, it's feeling super soon!
This experience has also told me that Einstein's theory of relativity needed one more tweak. Not just for variable motion, but for variable volition. The closer the surgery (anticipated date) gets, the more slowly AND more quickly time moves. More slowly because I want it to get here soon to get it over with, and more quickly because I want to stall because I'm scared. So there you have it, my brilliant addition to Einstein's theory of relativity.
It's weird to have that brought in, it's sort of making it a little more real... the surgery is coming - in 2 months. Which probably feels like a long time on that side of the blog, but I'm here to tell you that on this side, it's feeling super soon!
This experience has also told me that Einstein's theory of relativity needed one more tweak. Not just for variable motion, but for variable volition. The closer the surgery (anticipated date) gets, the more slowly AND more quickly time moves. More slowly because I want it to get here soon to get it over with, and more quickly because I want to stall because I'm scared. So there you have it, my brilliant addition to Einstein's theory of relativity.
Tuesday, June 21, 2011
Weirdest Coincidence
The guy who works in the cubicle right next to mine also had orthognathic surgery done, in 1998 - weird, right? Wait! It gets weirder! He had the same surgeon as I do, Dr. Voorhees.
Tuesday, May 31, 2011
New Surgery Date!
August 23, 2011 - the big day!
Just under three months away.
I called the insurance today and was finally able to make them see reason, so as much as you can preauthorize a surgery, mine's preauthorized! Yay!
Just under three months away.
I called the insurance today and was finally able to make them see reason, so as much as you can preauthorize a surgery, mine's preauthorized! Yay!
Wednesday, May 18, 2011
The Call Before the Appeal
Getting jaw surgery covered by my health insurance plan has been no easy feat, but I've read online that this is pretty par for the course, so I just keep chugging along...
Yesterday, I got some good news when I just decided to go ahead and call the insurance company rather than waiting and sending in a letter. I thought it would be good to clarify the reason for denial. Well, did you know that when an insurance company is deciding whether or not to provide something, they probably don't even have a copy of your plan handy?
But once I gave her a copy of my plan and talked to her about the specific pages I was referencing, she said she "totally saw where [I was] coming from" and that they're going to call my surgeon to clarify under which category it belongs. Yay! Progress!
Jared's waiting to get excited until they actually say they're going to cover it, but I get excited and depressed with each new development in the insurance melodrama. The one good thing I can say about it is that it's kept my mind off the surgery itself, which I'm pretty sure I don't want to be thinking about too much.
Yesterday, I got some good news when I just decided to go ahead and call the insurance company rather than waiting and sending in a letter. I thought it would be good to clarify the reason for denial. Well, did you know that when an insurance company is deciding whether or not to provide something, they probably don't even have a copy of your plan handy?
But once I gave her a copy of my plan and talked to her about the specific pages I was referencing, she said she "totally saw where [I was] coming from" and that they're going to call my surgeon to clarify under which category it belongs. Yay! Progress!
Jared's waiting to get excited until they actually say they're going to cover it, but I get excited and depressed with each new development in the insurance melodrama. The one good thing I can say about it is that it's kept my mind off the surgery itself, which I'm pretty sure I don't want to be thinking about too much.
My Diagnosis and Procedure Codes
The world of medical jargon wouldn't be complete without some seemingly meaningless numbers that actually define the whole process for you!
Here are my diagnosis (ICD-9)codes:
524.03: Maxillary hypoplasia
524.04: Mandibular hypoplasia
715.98: Osteoarthrosis, unspecified whether generalized or localized
729.1: an acute, subacute, or chronic painful state of muscles, subcutaneous tissues, ligaments, tendons, or fasciae caused by a number of agents such as trauma, strain, occupation, exposure, posture, infection, or arthritis; Inflammation and fibrous degeneration of a muscle; A common nonarticular rheumatic condition that is characterized by muscle pain, tenderness, and stiffness.
Here are my procedure (CPT) codes:
21085: Impression and custom preparation; oral surgical splint
21147: Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted bilateral alveolar cleft or multiple osteotomies)
21196: Reconstruction of mandibular rami and/or body, sagittal split; with internal rigid fixation
These are the codes that Dr. Voorhees has put in the information sent to the insurance company, although they, in my opinion, do not do the reasons behind the surgery or the surgery itself, any justice.
ERISA: seems good, actually bad
I learned that my health plan is ERISA (meaning that, probably like yours, it's employer-provided)
ERISA basically means that if you decide to sue the insurance company for breach of contract if they deny your claim, you are not allowed to sue for damages. Meaning that the most an insurance company has to lose if you take them to court is the cost of the surgery... so they're no worse off, minus attorney's fees, which you may or may not recover, and run about $40,000 for ERISA cases. Fun right?
Here's some information on ERISA:
ERISA basically means that if you decide to sue the insurance company for breach of contract if they deny your claim, you are not allowed to sue for damages. Meaning that the most an insurance company has to lose if you take them to court is the cost of the surgery... so they're no worse off, minus attorney's fees, which you may or may not recover, and run about $40,000 for ERISA cases. Fun right?
Here's some information on ERISA:
What does ERISA mean and how does it affect me?
ERISA is an acronym for a federal statute referred to as the Employee Retirement Income Security Act. This name is somewhat misleading because it sounds as though it only relates to “retirement income,” in fact, the act governs your entitlement to just about any employment related benefit, including retirement income, pensions, 401ks, disability benefits, group medical benefits, life insurance and death benefits and others. In addition, despite Congress seemingly passing a statute designed to protect the employee, the statute, in fact, does anything but that. The statute is a trap for the unwary and its provisions are slanted in favor of the employer or insurance company. It is an area of the law in which a person should seek legal representation.What Does Employee Retirement Income Security Act - ERISA Mean?
The Employee Retirement Income Security Act of 1974 (ERISA) protects the retirement assets of Americans by implementing rules that qualified plans must follow to ensure that plan fiduciaries do not misuse plan assets.
The Employee Retirement Income Security Act of 1974 (ERISA) protects the retirement assets of Americans by implementing rules that qualified plans must follow to ensure that plan fiduciaries do not misuse plan assets.
Investopedia explains Employee Retirement Income Security Act - ERISA
ERISA also:
1. Requires plans to provide participants with important information about plan features and funding. The plan must furnish some information regularly and automatically. Some of this information is available free of charge.
2. Sets minimum standards for participation, vesting, benefit accrual and funding. The law defines how long a person may be required to work before becoming eligible to participate in a plan, to accumulate benefits and to have a non-forfeitable right to those benefits. The law also establishes detailed funding rules that require plan sponsors to provide adequate funding for the plan.
3. Requires accountability of plan fiduciaries. ERISA generally defines a fiduciary as anyone who exercises discretionary authority or control over a plan's management or assets, including anyone who provides investment advice to the plan. Fiduciaries who do not follow the principles of conduct may be held responsible for restoring losses to the plan.
4. Gives participants the right to sue for benefits and breaches of fiduciary duty.
5. Guarantees payment of certain benefits if a defined plan is terminated through a federally chartered corporation, known as the Pension Benefit Guaranty Corporation.
6. Protects the plan from mismanagement and misuse of assets through its fiduciary provisions.
This act was enacted to address irregularities in the administration of certain large pension plans - particularly the Teamsters Pension Fund, which had a rather colorful history involving questionable loans to certain Las Vegas casinos.
ERISA also:
1. Requires plans to provide participants with important information about plan features and funding. The plan must furnish some information regularly and automatically. Some of this information is available free of charge.
2. Sets minimum standards for participation, vesting, benefit accrual and funding. The law defines how long a person may be required to work before becoming eligible to participate in a plan, to accumulate benefits and to have a non-forfeitable right to those benefits. The law also establishes detailed funding rules that require plan sponsors to provide adequate funding for the plan.
3. Requires accountability of plan fiduciaries. ERISA generally defines a fiduciary as anyone who exercises discretionary authority or control over a plan's management or assets, including anyone who provides investment advice to the plan. Fiduciaries who do not follow the principles of conduct may be held responsible for restoring losses to the plan.
4. Gives participants the right to sue for benefits and breaches of fiduciary duty.
5. Guarantees payment of certain benefits if a defined plan is terminated through a federally chartered corporation, known as the Pension Benefit Guaranty Corporation.
6. Protects the plan from mismanagement and misuse of assets through its fiduciary provisions.
This act was enacted to address irregularities in the administration of certain large pension plans - particularly the Teamsters Pension Fund, which had a rather colorful history involving questionable loans to certain Las Vegas casinos.
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