Tuesday, April 7, 2009

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.

11 comments:

funkyrhodes said...

:(

Let me say again..

:(

I don't know what to say...I'm sorry this is happening to you. In a typical guy move when encountering a female with a problem, I'm going to try to throw out a possible solution: try to sign up with another insurance company and resubmit your request. I'm sure there's a way to get this done. Check out different insurance companies and see what's out there...hopefully you can find something that is reasonably priced and can accommodate your need for surgery.

With all the cuts in the arts, I know how tough it is to stay employed in the school system as a music teacher. I still have hope for you!

Aimee said...

I wonder if you could apply for an individual plan at Kaiser. They pay 100% of the surgery. I wonder if it would be covered since you already have your braces on...I'm not sure. I can imagine how frustrating this must be. I hope it all works out! Keep us updated.

Anonymous said...

Steph:
I am so sad to hear about your so disappointing news. You have been such a trooper through all this, and I admire your persistence and courage. You have been through so much with this journey. Please don't give up the fight for your surgery. Sadly, your school insurance has not worked out, but perhaps researching private insurance (which maybe you keep for 6 months to a year) might be another way to go (you might be looking at a $200 to $600 premium per month (depending on your age and the state of your health)). This newest news so sucks Steph, and I am so sorry you are going through this. This is so unfair. Please keep posting Steph. Something has to work out. You want and deserve the surgery. Please don't lose heart.
Julie

Katherine (Kate) said...

Oh my goodness. I can't believe how upset you must be with all of this run-around. I am absolutely clueless about insurance and feel helpless to offer any advice on the subject. There has GOT to be a way, someone who can give you another avenue to pursue... anything...

Feeling for you, Steph and so sorry about this discouraging news. Cry, throw things, get good and ripped, you have every right to be angry. Then take a deep breath, courage, and pick up the phone again. There has GOT to be a way.

Thoughts and prayers are with you that a new way opens up for you *HUUUUUUGE hug* xoxox

Alli Kat said...

This is SO unfair. I am so sorry to hear this, Steph. I really wish there was some way I could fix this.

It's a total disgrace when our teachers can't get the health care they need.

*hugs*

holski said...

Steph,
I am so sorry to hear about all of this. You must feel terrible. I've been wracking my brain trying to think of a solution to this but I know nothing about insurance unfortunately. I have a question though... Have you looked into having surgery in another country and paying out of pocket?

Just out of curiosity, I asked my surgeon's office to send me a copy of the invoice that was sent to the provincial insurance that paid for my surgeries. Surprisingly, here was the breakdown:

Lefort 1 and bone graft - $1479.93
BSSO - $2096.51

I have no idea if these prices included my hospital stay (probably not). But it was far less expensive than I thought it would be.

Here is the website for my new surgeon who I've met and is great:

http://www.drbourget.com/

Here is the clinic where I went for my second surgery:

http://omsconsultants.ca/oral_surgeon_nova_scotia/cyr.aspx

Maybe you could call them and ask them if they ever treat American patients who pay for themselves. I know that Americans can come to Canada to have cosmetic surgery, so why not orthognathic? I dunno, you or someone else reading this might already know the answer, but I thought I'd through it out there. =)

Hope you're feeling better today. Be strong girl!

holski said...

Check out this site...

http://www.choicemedicalservices.com/

I mean, I know this is not ideal, but it could possibly be an option, if there are no other options.

Anonymous said...

Along Holly's suggestions, I heard that Dr. Oscar Reiche in Costa Rica is an excellent orthognathic surgeon. A patient of Dr. Reiche posted pics of her surgery on the archwired support group, and I was stunned by how impressive the results seemed to be.
Dr. Reiche reportedly trained with a famous US orthognathic surgeon, Dr. Larry Wolford.
Julie

stephanie said...

Thanks, guys. Between you all and a nice chat with the husband, I'm feeling a bit better. Now there's nothing to do but wait until my hearing on the 30th. I'm trying to keep positive and look at my other options until then.

My husband also said to remember that I was talking to a lowly little customer service representative - someone who probably makes minimum wage and doesn't make any decisions - that it will come down to the "real" people at the company and my school district. So, that gave me hope as well - even if it may or may not be true.

Thanks, guys. You're the best.

changes911 said...

I am pretty sure that Keiser covers Clali, and washington. Look into it. I had a friend who had Kaieser and they were really good. Granted, he did not need orthognathic surgery, but his insurance plan kicked ass! I am so sorry that this had to happen to you. You seem like such a nice woman. This really sucks. I am going to do some reserch and see if I can help you out okay. I don't know anything about insurance companies and things like that, but I will still try to help. They have me at the front desk at work today so I have acccess to a computer. I am going to spend my day trying to help.....also have you tried going to a doc at a dental school? Like at your local university?

Stephanie said...

Im so sorry your going through this, Im lucky as my insurance didnt even blink and eye and covered both by surgeries. Your letter sounds great and is very articulate in why it is medically necessary. Ill keep looking for your updates, stay positive!