feeling better already

It all happened so fast today. I arrived with my best friend in tow - she came along for moral support - and I was allowed into the meeting, I met the 6 people (secretary, 4 board members, and the manager guy I've been working with), and they asked me to tell them a little about me. I pretty much summarized my appeal letter. They asked about the surgery procedure, recovery time (would I have to take time off work? No, it's during the summer), sick days, migraines, etc. They asked what I would do if the surgery wasn't approved - I told them I didn't know, and that medical loans or looking for other means would have to happen, as I couldn't wait. They asked about the insurance - and I told them that I qualified as medically necessary - which I DO! They asked about my surgeon being in-network - and she IS. So, to summarize, yes, it is just the contract exclusion barring me from the surgery.

So, it was all anti-climactic. I can call next Friday to find out the results - they can approve me in full, deny me in full, or approve me in part - like they would pay a portion of the costs.

As it always is, I can't imagine them deciding to deny the surgery that I so obviously need. But on the other hand, it's so damned expensive and I already know a handful of people being RIF-ed (reduction-in-force) from music jobs. It's not like they couldn't replace me.

So, if you're the praying type, continue those prayers. At least it's over. Maybe I'll sleep tonight? It feels good to have it done with. I keep wondering if I could have said more, what I should have said - but I was sitting at that table just trying not to cry. They have such a large amount of information that I'm not terribly worried about not saying enough - everything I said was in the packet they received.

Well, to be continued...

almost there...

I'm still waiting for Thursday with no peace. With my skin suddenly breaking out like crazy, this stupid drama with insurance, and the braces, I really fit into the middle school scene this week!

Migraines have been pretty terrible this week - though it still feels so much better than last Friday I feel quite blessed. The ER really did the trick!

The good news? My gaps in my lower arch are pretty much closed now! The right one seems to be permanently closed, but the right one will close tight enough for me to need to actually floss (!!) but then the next night is open and I need the little brush. But it's pretty much there. I still feel like my teeth are tipped on their sides and don't meet at all but I suppose that will be taken care of at my next orthodontist appointment - the end of next month.

Thanks to everyone for their kind words and prayers. They are gratefully accepted as I come closer and closer to the appeal hearing. I'll post afterwards with my opinions about it, but will not have an official decision until after May 7th.

Until then...

another ER visit

What a terrible day. It all started out around 1am puking from a migraine - my splint had fallen out somehow during the night. I tried going back to sleep with a painkiller, puked again, then finally was able to sleep, thinking that once I could get to sleep my migraine would improve. Instead, I woke up and it was worse - so bad that I could barely look at the computer to call in sick, let alone type lesson plans for the day.

After trying to take something for the pain again I started to puke again and I knew it was time for the ER - but I had no clue how to get there without Nick. So I called my mom in Shelton (about an hour drive) at work, and she left work early (7 hours early) and drove up and took me to the ER where I spent a few hours with an IV and shots of painkillers. A 5 hour nap later and I felt pretty good, but what a terrible day. The migraine is still around - never got it below a 2 or 3 out of 10 pain wise, but that's pretty much as good as it gets anymore.

Whoa.

still anxious

I am still achingly anxious over the hearing on the 30th. I get a wave of nausea every time I think about it. And the 30th isn't even the end of it - they don't even meet with the entire board to make a suggestion and vote until May 7th, I believe. Of course I'll request to be notified as soon as possible afterwards, but that might not be until the next day, I imagine.

All I do in my spare time is think and mull and wish I knew how to prepare myself for this hearing. Will they have any questions for me? Should I bring them case studies of other people in similar situations (ie overbite, migraines, duel jaw surgery)? How can I convince them that NOT having the surgery is not an option? And that there's just no way for us to afford the surgery on our own? And if I end up not being covered, how do I go about figuring out how much it will all cost if I pay in cash (er, credit card?).

Argh. I'll try not to complain too much more, but it's just where I am right now. Feeling pretty low, missing the husband like crazy, getting low grade migraines every single day lately and terrible jaw pain, and feeling like this might go on for a long time. A long, long, long, long time.

As a final note, I can't believe that I'm able to teach middle school band and orchestra with migraines. In college, the first 10 minutes of a migraine would have me running for my bedroom, where I'd turn out the lights, put a cold cloth on my head, take my migraine medication and sleep for 12 hours or longer - until it was gone. It would have taken a huge occurrence (a test, juries, performances) to get me out of bed. Now, I have a migraine almost every day - but I'm used to not seeing well out of my left eye. I'm used to feeling nauseous after eating. I'm used to only one set of lights (out of 3) on in my classroom - sometimes none when I can open the windows and let a little light in. I'm used to the reverb that makes me dizzy when my kids play too loudly. I'm used to being short and snappy with my students. I'm used to not being able to speak clearly or think clearly enough to give feedback on performances. It's such a part of my life now, I can't imagine life without migraines.

Ugh.

Ugh.

Ugh.

anxiety

I am having major anxiety about the benefits hearing on the 30th. I can't get it out of my head, and the stress is leading to me clenching my jaw, especially at night... which of course makes the jaw pain worse and worse and I've had a constant migraine headache for the past week.

This whole situation is depressing me more and more. I don't understand how it's legal for an insurance company can simply "exclude" a surgery that could be medically necessary - how is that possible?! Why do I have insurance if it doesn't cover everything I need? Is it because of the cosmetic factor? Because I understand that. But I also understand that with sufficient testing and positive results, it should be covered - no questions asked.

Pity poo party time. This just isn't fair.

update part deux

I completely misunderstood what was happening with my school district vs. insurance company. Since there IS a specific exclusion, it's up to my school district to pay for my surgery or not to pay for my surgery. End of story. I don't know where THAT misconception came from, but it sure was a big one - I had my poor insurance company (ha) on a wild goose chase. Oops.

I feel like I'm completely annoying the school district people. I don't mean to inundate them with information about my situation - but it seems like the more they know, the easier making an informed decision will be for them. And since this doesn't seem to be the most common problem in the world, I want them to understand what my daily life is really like. And I want them to understand that this is a last resort - not just a flyby could-possibly-help surgery - it will change my quality of life considerably. CONSIDERABLY. I've tried so many things to make this better and have had migraines my whole life - to think that I could go for weeks without a migraine? To think that I could eat a steak or chew a piece of gum and not be sick for a week? To chew breakfast, lunch, and dinner? To not have to worry about playing my clarinet or trumpet in class or in rehearsals too much. To be able to play my saxophone. The list goes on and on and on.

Well, all I can do is wish and hope and pray. And leave the insurance and school district benefits people alone.

Oh! I wanted to put out MY appeal letter in case someone is writing their own - it took me FOREVER to write and had it not been for help from Stephanie I'm not sure it would be as decent as it is.

To Whom It May Concern:

I am writing this letter to serve as an appeal to the denial of insurance coverage for the surgery recommended to me by Dr. Bruce Molen, Dr. Rick Molen, and Dr. Jessica Lee. This surgery is medically necessary, and Regence Blue Shield turned me down because the plan specifically excludes orthognathic surgery – not because of medical necessity. I would like to appeal that exclusion.

I have been exploring non-surgical methods to deal with my migraines and chronic jaw discomfort since college with limited success. While I had gotten migraines prior to college, they were solely hormonal in nature and very seldom. In college when they began to occur frequently, I began to seek treatment at the medical center in Ellensburg. My doctor tried topomax to prevent migraines, which had no success. I responded to Imitrex taken early on in a migraine, but after 4 years of taking Imitrex I began having “rebound migraines” every time I took it. I am now on Zomig, which is only minimally successful in treating my current migraines. I also suffer severe side-effects from Zomig.

When I had my first consult with my orthodontist back in November of 2007, I was only interested in straightening my teeth, as they were becoming too crooked to play my clarinet well. After showing me the misalignment in my jaw, he asked me if I suffered from migraine headaches, and then explained that all of the tension in my jaw (from posturing it to a “normal” position) was likely a cause of most of my migraines. I was amazed.

Currently, to prevent migraines and to relieve jaw pain, I wear a splint at night and during the evening hours to help my jaw relax and to prevent me from clenching. I have seen chiropractors, massage therapists, and acupuncturists. I take ibuprofen 3-4 times a day and Amrix, a muscle relaxant usually only used in the short-term, every evening. I have also completely changed my diet to prevent migraines and jaw pain. I do not chew food for more than one meal a day. My diet consists almost solely of oatmeal, yogurt, soup, smoothies, and pasta.

Despite all of these precautions, I have moderate to severe jaw pain almost every day and a migraine headache 3-5 times a week or more. I have already missed 10 days of work this year from migraine headaches so severe I am unable to function. Last year I missed 9 days of school due to migraine headaches. I have also missed countless rehearsals outside of school and days of work at my part-time job. A migraine headache for me consists of blurred vision in my left eye, sensitivity to light and sound, nausea and vomiting, severe pain in the front left side of my head and temple, and dizziness, plus muscle pain in my jaw and the muscles around my jaw.

I am a middle school band and orchestra teacher. I am also a semi-professional musician who plays clarinet for organizations around the south sound area. As my jaw has continued to deteriorate this year and migraines have become more and more frequent, I have been forced to turn down performance gigs. I also find myself not playing examples for my students in class for fear of migraines and jaw pain. I can often be found in my classroom with the lights down low and wearing earplugs to try to keep my pain level manageable.

If my condition is not corrected I have a very high chance of my symptoms continuing to get worse over the years. I have already watched my symptoms get significantly worse over the last two years, and personally and professionally I cannot allow them to continue to deteriorate.

Thank you for the consideration of this appeal. Dr. Molen, Dr. Lee and I would be happy to discuss with you in further detail about this procedure if necessary.

Respectfully,
Stephanie Sheppard

the options, as I see them

For the most part, I am feeling better. Maybe better isn't the right word - I'm feeling numb. In spite of everything, I am trying to think positive about everything. My husband reminded me that I spoke to a customer service representative, not an expert in insurance and in private insurance agencies like my school district. AND... even if that is the case, there may be a way around it. And if there's not, well... I'm researching other options as we speak.

Some findings today: in California it's against the law to deny a patient orthognathic surgery? I looked for laws similar to this in Washington, but there weren't any to be found. It's looking like private insurance really isn't an option for me. I have researched countless plans - Kaiser isn't available outside of southwest Washington, Regence has an exclusion, Assurant has a $500 dollar maximum payout for jaw related surgeries (HA!), Lifewise has an exclusion, Premera Blue Cross has an exclusion.... and those are the major companies in WA.

I am not ready to quit my job for this. Now, the quick of the matter is that I am also not ready to spend the next year with the same jaw pain and migraines. My jaw pain is becoming more and more severe every day, and it's driving me crazy. I mean, I have never been in this much pain in my life - and that includes 6 years with carpal tunnel and tendonitis - so bad that I had to take a quarter off of playing my clarinet in college because I couldn't open doors with doorknobs or put my hair in ponytail - my fingers and wrists were too sore and stiff. So I've been in pain before. This is so. much. worse.

Another option? Having surgery outside of the US. But I'm not even sure of how to go about this - do I call an individual surgeon? Do I have to call a hospital? How do I pick a surgeon without the help of an orthodontist? I would have the surgery in Canada because I'm relatively close living in Washington state. It wouldn't be out of the question to drive up there and spend a few weeks, and I can always fly back for post-op appointments.

Another option could possibly be the army. Nick is currently just in a 9 week school, but his next school places him in active duty for at least 48 weeks, possibly more. Maybe I can somehow be covered by the army insurance? Do I really want an army surgeon doing my surgery? The only time I went to see a doctor at Madigan I had bronchitis. I used to get bronchitis at least once a year, so I knew what it was - no doubt. After I told the doctor this, he listened to my chest, wrote me a prescritption for ibuprofin and told me I had a cold. A week later I was in the emergency room because I couldn't stop coughing - and it had turned into pnemonia. Needless to say, I don't have a lot of faith in the army medical system.

Otherwise... I wait until Nick is done with language school and hopefully gets a job with good health insurance? But that's at LEAST a year from now. Probably more.

And there are my options, as I see them. In the end, I'm just praying that my school district sees me behind the millions of dollars this is probably going to cost. I'm praying that they say yes. Because I don't know how I'm going to handle it if they do say no.

It kind of feels like I've jacked karma somewhere along the line - I spend 5 years at college doing everything I can to make myself a good teacher and a good candidate to hire. I spend my first two years out of college working in random jobs outside of my comfort area - not to mention one was a long term sub job and one was a leave replacement contract. So now I've got a job with wonderful kids in a wonderful location and a continuing contract... but for some reason this district doesn't use the bloody union insurance - the perfect insurance that covers everything I need at 95%.

Alright, I'm done with the depressed musings now.

and the bad news just keeps on coming...

I called to check on my insurance company today - to make sure they weren't forgetting about me and my lovely, confusing case. In doing so, I managed to get the worst information I could have possibly gotten, therefore making me believe there isn't any possibility for my surgery to come through.

I'm sobbing as I type this, wanting for nothing else except for a hug from my husband and for a jaw surgery fairy to come along and grant me my one wish.

Alright, the bad news (in 2 parts). First part - there isn't a way for my school district to grant me an exception for the stupid orthognathic surgery exclusion. They would have to change the policy for ALL members... which I'm sure is really expensive. So, thinking on my feet, I asked what would happen if I paid for the surgery out of my own pocket- the response? I would have to pay for EVERYTHING out of my own pocket - including the overnight hospital stay, operating room, the whole shebang.

Because all this while I kept thinking in the back of my mind that we could manage to pay the almost 14,000 dollars on our own. We have excellent credit and a few empty credit cards with large limits.... But that's stretching it. I can't afford the 100,000 dollar everything else - let alone if something (god forbid) goes wrong - and what? It costs 200,000 dollars? 300,000?

Nope, sorry, no way.

So what do I do? Look for a new job in a state where music programs are being cut in practically every district? And then be stuck at ANOTHER school - a new school 4 years in a row? No! I like my school, I love my kids, I like my district - if it weren't for all this crap about jaw surgery.

I just don't know what to do.

I love my orthodontist

Look at this letter! It was worth waiting for.

Dear Sir or Madam:

Stephanie presented to me for an initial orthodontic consultation on November 30, 2007. Her subjective complaints included migraine headaches, chronic TMJ pain, and chronic oralfacial muscle pain. Stephanie also reported severe pain upon eating hard foods and had therefore contained herself to a diet of soft foods.

Upon clinical examination it was noted that Stephanie exhibited excess gingival display due to excess maxillary vertical growth. The mandible also displays excess vertical growth giving Stephanie a dolichofacial facial type. Popping and clicking was detected in both temporomandibular joints. Class I molar occlusion was noted bilaterally with moderate crowding in the upper arch and severe crowding in the lower arch.

Cephalometric analysis revealed a mandibular plane angle of 53 degrees, where the normal measurement should be 33 degrees. Her SNA was 74.5 degrees (norm: 82 degrees), her SNB was 67.5 degrees (norm 80 degrees), and her resulting ANB was 7 degrees (normal: 2 degrees). The cephalometric analysis demonstrated that despite Stephanie's Class I dental occlusion she has a severe Class II skeletal relationship.

It is my opinion that this discrepancy between the dental and skeletal relationships is a major underlying contributor to her current muscle and joint pain. It is my opinion that Stephanie's TMJ and muscle pain are secondary to her skeletal deformity as previously described. If Stephanie's skeletal deformity is not addressed soon via surgery she will be at very high risk of developing permanent joint changes leading to a lifetime of continued joint and muscle pain.

Respectfully,
RM, DDS

Okay, so to tell you the truth I don't understand what most of this letter says. Anyone? Anyone? What's all that degree stuff mean? And I have excess vertical height on my mandible, also? No wonder my face looks kind of horse-like (growing up, I HATED the "why the long face" comments I used to get).

He also included x-rays and photos from my initial appointment - and sure enough, my TEETH were Class I! Who knew? No wonder I had no idea that I had an overbite - I didn't have one! Now there's no denying it, for goodness sake.

This gets dropped off at my benefit coordinator's office TOMORROW, along with my journal of pain and migraine counts - I'll post that and my personal appeal letter soon.

orthodontist appointment today

Not really an exciting orthodontist appointment today. I have the exact same configuration, just adjusted with a little more tension on my springs and new rubber bands. I was partly excited (hopefully I will avoid one of my killer post-orthodontist-appointment migraines because they didn't really change much)... but mostly disappointed because SHEESH do I want some of this metal out of my mouth! I have NEVER been a wax user, but as of the major metal additions I have been a real addict to the stuff - and I don't play trumpet or clarinet as much for my kids during class because I hate having wax in while I'm teaching.

Yeah, I'm a diva. So what?

More appointments, though. In the last week of May I have a last-minute checkup appointment to make sure everything's going as planned. Then on June 23rd I get my surgery hooks on - a full week before surgery (blegh), but that was the only date they had open as they go on a vacation right around that time. I also will be getting my impressions taken with the hooks in, which ought to be a BLAST!

My husband's leaving tomorrow morning for his training with the national guard. He'll be gone from anywhere from 9 weeks (if he goes to the first school only) to almost 60 weeks (both schools in a row). Ugh. I still have hope that he'll be home for my surgery, but it is quite bleak.

oh good grief!

I stumped my insurance company.

Today I decided to call the insurance and see if I could work out the "problem" of a medical necessity appeal PRIOR to my school hearing on April 30th. It took a long time to explain what I needed and what my situation was (granted, it's probably pretty odd). She put me on hold for almost 10 minutes when she came back just to "check on me." 5 minutes after that, she told me she had emailed out her question/ my request to a bunch of people and would call me back when they got an answer. She had no idea what to tell me.

Good grief. Hopefully they'll let me go through with it, though! I don't see there being enough time if I'm approved on April 30th (for it to be included in my plan) and then denied by insurance - I would have to go through the entire school process again. I might have time, but it would be too close for comfort.