my friend, bizkit

For all of you feeling down out there in ortho-bloggerland, just watch this. The first time I watched it, I laughed so hard I cried. That's right.

I tried to embed the video, but for some reason I am unable to copy the entire link. But really - it's worth the 24 seconds of your life, especially if you need a pick-me-up.

http://www.youtube.com/watch?v=z2BgjH_CtIA

the teefs

The teeth sure are looking good! I thought I'd take some pictures while I was thinking about it (and I'm bored out of my mind stuck at home taking care of the husband in his last week at home - who has the same terrible worst-cold-ever cold that I had last week). So I've been reading some jaw-surgery journals, lurking on the yahoo orthognathic surgery group, and generally freaking myself out about the upcoming surgery. Now that it's almost April, and all of my blog-buddies have surgery dates in the next two months (and I've got one for just 3 months out) I'm getting a little nervous.

Otherwise, my gaps are closing. Now I'm forced to use the small brushes to clean out in there, and soon I will be flossing! I have been thinking a lot about surgery lately, and I don't think I will be needing the lower expansion. I can't believe how much wider my lower palate is now - it's like looking at a different mouth. My top teeth are finally looking straight, though, which is nice - I thought that would never happen!

The overbite is growing at a pretty pace once again. A few days ago I bit down really hard on a piece of bagel and my top teeth came down on my lower braces - whoa! Not only was it painful, I thought that I had bitten off a bracket. But, they are tough as nails and didn't budge a centimeter. Sorry the picture is a bit funky - you can see up my nose and at my glasses! But it shows the overbite in all it's glory. Triple yuck.

And now, my smile! Now, yes, it is marred by a million pounds of steel and titanium and springs and rubber bands, but check out how much wider it is than in the beginning - where there used to be pockets of dark space, now there are TEETH! Yahoo!

oddly enough...

My face is getting thinner. Over the past few months I've wondered about people asking me if I've lost weight. No, not really... But I was checking out my staff photo from the beginning of the year - and while I am relatively the same weight I was then, my face is quite thinner. My cheekbones look different. My face looks... taller, almost?

I'm wondering if maybe my jaw joints are actually moving? This thought scares me and really makes me want to run to the nearest doctor and check out my joints ASAP. Weird. Am I being paranoid? Possibly. More than likely.

No updates on the insurance stuff. I caught the death cold from the Annie production kiddos [I was playing clarinet] and spent the last two weeks barely surviving the combination of migraines, sinus, really high fever, coughing, runny-nosing, et cetera et cetera et cetera (I'm on a musical kick... a gold star to whoever can name THAT musical). And the best part? I have 2 sick days left for the rest of the year, which I am pretty much forced to save for puking migraines. Because while it is possible to teach band and orchestra with a fever and chills and cough and sinus stuff, it is impossible to teach while puking. Lame.

I'm on spring break [can I hear a hallelujah?!] this coming week so I'll get everything taken care of - and at an hour where the customer service people aren't rushing me off the line so they can take care of the next 100 customers on hold.

And speaking of puking migraines, I have an orthodontist adjustment on Thursday (hooray! we can talk about surgery!). I'll post more pictures before then, as my gaps are almost... well, not gaps.

appeal appointment

I went down to our benefits office today to ask some questions about what I was needing to turn into them, and I ended up turning in my packet and getting an appeal review date. On April 30th I will be pleading my case before an appeal committee. About a week later they'll give their recommendation to the board of trustees, and then I'll be notified. I can then appeal their decision, I think, if they deny it. The could decide to pay for it in full, deny it in full, or pay for the surgery in part.

I just realized today, however, that there will be a hitch in the road: Right now I'm just trying to convince them to allow my coverage through Regence to ALLOW orthognathic surgery - just allow the idea of having surgery. In reading through other people's experiences, often insurances deny the patients the first time around, making them prove that the surgery is medically necessary. I asked the coordinator today - what happens if I get approved for the surgery to be considered, but then denied through Regence the first time? His answer? Go through the whole appeal process again.

So tomorrow I'm going to call Regence and see how they determine the surgery is medically necessary and see if I can go through that process PRIOR to April 30th so I can skip that bump in the road.

I feel like a hamster.

new date

I have a new date for surgery. It's now July 1st, as Swedish Medical Center's same day surgery unit is closed on the 3rd. It's pretty much my perfect date in the world - I wanted June 30th or July 1st, and July 1st it IS!

So many appointments to make - I have to have my surgical hooks on before my appointment on June 25. On June 25th I have my records appointment at at 9am, my pre-surgical consultation at 10:15am, my business office appointment at 11am. I also have to make a pre-admissions appointment with Swedish Medical Center. I'm hoping to do that in the afternoon on the 25th, because that way my mom will only have to come up and miss work for one extra day, instead of two.

I'm scheduled to check in at 8:45am on Wednesday the 1st. I can't eat or drink after midnight on the 30th. I have a post-op appointment on July 9th at 1:00pm.

With help from Stephanie (thanks, Stephanie!) I am almost done with my personal statement. I am hoping the letter from my orthodontist will come in the mail... I think that's all I'm waiting for before turning my packet into the school district. I want to get this appeal show on the ROAD. On one hand, I keep telling myself that there is no way they'll see my condition and still deny me, but on the other hand it's so much money I'm worried they won't approve it. 13,000 dollars is a LOT. AND, I'm struggling with whether or not to share that my former insurance (the one most school districts carry as it's the insurance through our union) was going to cover the surgery, no questions asked, at 95%.

I'm going down to talk to them tomorrow at their office tomorrow. Everything seems like it takes so long. Once my forms are all filled in and filed, the "Executive Director" has 15 days to assign a claim review number. This claim review has to be received at least 30 days before a Committee meeting, and if the next meeting is full it could be postponed to another meeting. If I don't attend that meeting I waive the right to initiate a review of the claim at another date. The committee then has 30 days to get a transcribed copy of the meeting. Then (later) the committee votes and within 30 days of THAT they have to notify me of the result. WHOA!

In THAT kind of time-line, surgery is TOMORROW! I'm pretty much freaking out.

insurance update

Every day is exciting when you're dealing with insurance companies, let me tell you. Right after I got home on Thursday I called the insurance company to figure out how to start my first level appeals process. The lady I got ahold of said that there was nothing to appeal, as the procedures and materials for orthognathic surgery are specifically NOT a part of my benefits package - they are specifically excluded.  We talked for quite a while, and she ended up recommending me to write a personal statement about why I thought I needed the surgery despite what my insurance covered, and to label it as a "second level appeal" instead of a first level appeal, which I should be doing. 

I called my school benefits people shortly after, and explained to him that I can't appeal something that hasn't been denied, and that I was worried it would take a long, long (too long) time to get another denial before I can start appealing with THEM.  So he sent me the package and kind of explained what I have to do. 

I have to write a personal statement and get letters from my orthodontist and surgeon about why the surgery is necessary.  I have to get documentation from every person that's seen me for my headaches or jaw pain.  I need to have an estimate of what the surgery will cost.  Then I'll hopefully appear at a hearing with the school benefits people where I'll plead my case prior to them making a decision.  I've also got a "jaw functionality" report that I need to fill out for my surgeon's office (and I'll be using it in my hearing).  

I'm so scared.  If any of you out there has example letters that you've written to appeal your case, can you share them with me?  I'm really confused on how to write my letter/personal statement...  My email is sheppard.stephanie@gmail.com or stephanierae2804@yahoo.com, if you don't want to put them online.  

Our computer has been pretty wonky lately, so if I don't respond to comments quickly it's because I can't get on blogger from my school internet.  I can check both emails, but that's about it.   

I'll keep updating as I get more info. 

mark your calendars...

Because I have a DATE! July 3rd, 2009. I have my pre-op appointment on June 25th to do all of the bloodwork, tests, etc.

Now, to just get it paid for. After I got the denial letter, I made a phone call to my insurance company. They told me I needed to go through my surgeon for the appeal. I called my surgeon. They didn't call back. I called my surgeon. They said that I had to go through my human resources department or benefits coordinator - because I could appeal until the cows come home - and medically necessary or not, my plan automatically excludes orthognathic surgery of all kinds.

So, this morning I called my benefits office. THEY told me I have to be denied AGAIN by the insurance company before they become involved. Tomorrow (or tonight if they're open past 5pm) I'll call the insurance company again and tell then what I've been told since our last conversation. What a giant joke.

But I have a DATE!!