and...

My insurance has to be the insurance that costs 237.00 a month. To save me some money, I am able to use the "normal" 45.00 a month insurance until January - because I can change to the expensive insurance during open enrollment in November. But I'm stuck with that expensive insurance for an entire year.

Bummer, to say the least. But I called my oral surgeon and she said that I can schedule my surgery in March. Wahoo!

Does anyone know - is that enough time for the appeal process? Or should I start appealing come January?

decisions, decisions

I have to make my insurance decision by Monday.... I think, though, that if things go terribly wrong I have the chance to change them when open enrollment comes in November. I called the other insurance choice, and they have a similar policy for orthognathic surgery - it is simply not covered except for in specific cases, but you can appeal.

Now that THAT is over (finding out that surgery could possibly be covered in two of my insurance choices), now I need to figure out which one covers the hospital and Dr. Lee. Hopefully in-network.

I left (another) message for Dr. Lee's patient coordinator, and I'm sure I'll talk to her tomorrow.

Keep your fingers crossed that the UHC insurance covers the hospital/ surgeon - because it's only 45 dollars a month, as opposed to 237 dollars a month. With everything else, coverage wise, being pretty much the same.

PS. Ran in to get some more splints today because mine are all wearing through - ended up getting a 20 minute appointment where my two orthodontists chatted with me about what's going on! I love my orthodontists. They are also trying to get me off of the splints and onto something different that isnt' so expensive OR so chewable. We'll see how it works, although it doesn't seem promising to me. I'll post pictures soon.

short quip

True story: Dancing in San Francisco last weekend, I ran into someone I had met in the summer of 2005 dancing in California. The first thing she says to me when she realizes it's me? "Ohh, you didn't have braces then!" like they were a permanent fixture on my teeth.

No kidding, super sleuth.

blogger is a pain!

Blogger issues = I didn't post the picture of the splint itself yet can't put it in there now, after the fact. So here it is, in it's splint-y glory:

And for the heck of it, a picture of my friend Heidi and I after running our first 10k! :) (In all of our sweat-y glory, ah hah hah!)

splint and new progress

Progress pictures! My front teeth are finally starting to look straight! A few nights ago I looked in the mirror while I was brushing my teeth and I realized that my front tooth was no longer sticking out at such an angle. Hooray! My overbite doesn't seem to be getting much worse this time (thank goodness... it's awful).

As I get further into teaching, my jaw is getting less and less mobile. Today during my beginning band class, the last class of the day I teach, my jaw actually locked closed for a little bit. Luckily, the kids were working on note reading, so I didn't need to talk. OUCH! The headache of tonight is incredible.... today was also probably due to the fact that I played my clarinet last night for band rehearsal, the first one since the spring.

I wish you could see it in this picture of my bottom teeth, but my front teeth are starting to get slight gaps in between them. Crazy! The big gaps from my extractions are closing up with a quickness... which is good, but they are becoming quite good at trapping food. Ugh. No more rice cakes for me at lunch. ;)

Anyway, tomorrow during my lunch time I'm going to try to call my oral surgeon's office so they can help me make my decision about insurance. Hopefully they know what kind of a time frame I'm looking at for appeal processes, how likely or unlikely each company was to accept the appeals, etc. Two insurance choices cost me around 250 dollars a month (OUCH, especially when last year it was free), one insurance costs me overall around 50 dollars, and one 30. I'm voting for the lower cost ones, of course, but I'll do whatever it takes to get my surgery to happen. Money might get really tight, but that's okay. We'll manage.

And last but not least.... my beloved splint. It's got water in the pads that go between my back teeth at night, and it rests itself on my upper gums right above my braces - my braces kind of anchor it in place. It's impossible to talk while wearing it, so wearing it while teaching is out. It makes me sleep with my mouth wide open (well, just forces my mouth to be wide open, and if I try to force my lips over it for long periods of time I get worse headaches than I had before the splint). So I have to have water around while I'm wearing it, or I get sore throats. The last negative thing is it's irritating my gums something fierce - which my orthodontist warned me it might. I switch it from upper to lower jaws, but it works best when it's on my uppers. I LOVE it. When I'm wearing it, it feels like my jaw just settles into where it's supposed to be, and instantly I lose tension all the way from the top of my skull into my shoulders. It's amazing. I'm in heaven.

Apologies for the fairly disjointed post... My mind is swimming with an upcoming dancing trip to San Francisco (Friday), missing instruments, teaching stuff, staff stuff, teeth and insurance stuff.... I decided I'd come home tonight and go to bed at eight :) Yay.

feeling better

We haven't gotten internet in our new apartment yet, hence the sudden lack of updating. I am appreciative about all of your lovely notes and comments.

Between you guys and one of my good friend's sister (who is a lawyer, and tells me she'll help me appeal once the time comes), I am feeling much better. While I don't technically qualify at this point, I feel that I can medically prove I need this surgery.

The splints at night really are improving my headaches, too - even during the day. Once we get internet again (end of the week or so), I'll post pictures of them. While I still have headaches almost every night, at least it's not during the day when I'm teaching middle school band and orchestra :)

And speaking of middle school band and orchestra, while I got quite a few questions about the braces from teachers and adults, not ONE student even really payed any attention to them. Gotta love middle schoolers :)

I'm breathing :)

"extreme cases"

Here's the lowdown on extreme cases. I don't qualify, by the way.

"Orthognathic surgery involves the surgical manipulation of the facial skeleton, particularly the maxilla and mandible, to restore the proper anatomic and functional relationship in patients with dentofacial skeletal anomalies, which may be caused by congenital or developmental anomalies or by traumatic injury. (1)

Note: This policy does not address surgical treatment of temporomandibular joint dysfunction or the surgical management of sleep apnea; discussion of these conditions may be found in Medical Policies, Surgery Nos. 49, 122 and 142.

Policy/Criteria
Orthognathic surgery for the treatment of obstructive sleep apnea may be considered medically necessary when the criteria in Surgery, Policy No. 49 are met.

Orthognathic surgery may be considered medically necessary to correct jaw and craniofacial deformities in the absence of obstructive sleep apnea when all of the following criteria (1-3) are met: Significant functional impairment is documented as a result of illness, injury, congenital anomaly, or developmental anomaly.

Significant functional impairment must be directly attributable to jaw and craniofacial deformities and must include one or more of the following:

• Chewing-induced trauma secondary to malocclusion
• Significantly impaired swallowing and/or choking due to inadequate mastication secondary to malocclusion
• Significant speech abnormalities (e.g., sibilant distortions or velopharyngeal distortion) which have not responded to speech therapy and are secondary to malocclusion
• Loss of masticatory or incisive function due to malocclusion or skeletal abnormality
• Airway restriction

Significant over- or underjet as documented by one of the following:

• In mandibular excess or maxillary deficiency, a reverse overjet of 3mm or greater
• In mandibular deficiency, an overjet of 5mm or greater
• Open bite of 4mm or greater
• Deep bite of 7mm or greater
• Less than six posterior teeth in functional opposition to other teeth secondary to a developmental or congenital growth abnormality (as opposed to a consequence of the loss of teeth)
• The functional impairment and over- or underjet are not correctable with non-surgical treatment modalities.

Orthognathic surgery in the absence of significant physical functional impairment is considered cosmetic, including but not limited to when used for altering or improving bite or for improvement of appearance.

The following documentation is required to determine medical necessity for orthognathic surgery:

• Current study models with the appropriate bite registration and/or the back of the models trimmed such that they represent the patient's current pre-surgical centric occlusion and/or centric relation bite
• Intra-oral and extra-oral photographs
• Cephalometric x-rays
• Diagnostic report
• Panorex x-ray

okay, freak out now.

None of the available insurance plans cover orthognathic surgery except for in extreme cases. I can go through a lengthy appeal process with my school district, but even then I'm not sure what my chances are about getting it approved.

So.... a lot of random crying going on. I think I'll just have to have my orthodontist put me back together again, fix my bite as much as possible, and remove the braces - I can't afford this surgery without insurance, and I can't afford to have my bite get any worse. I have shooting pains in my jaws all the time now, and I'm getting migraines every other day or so.

And it's considered "cosmetic." What a bunch of shit.

do. not. freak. out. (yet).

While I was initally pleased (understatement of the year, right there) about my new teaching job, now I am freaking out. I just got back from my new hire orientation, where I learned that my new school district has a really messed up version of insurance. And instead of getting a plan for free in my old school district that would pay for 95% of my jaw surgery, I don't know if it can get covered at all. Two of the five plans cost me 237.00 a month, one costs 25.00 a month, and one costs 45.00 a month (the final is group health, which isn't an option). Now, don't get me wrong, it'd be pretty darned good insurance... if I didn't already have a surgeon that I love and that is working with my orthodontist.

I don't know what to do with myself. I called the patient coordinator to HELP, but they were already out of the office. I'll call again tomorrow. And since my husband is doing the whole army thing come January, his current insurance can't help me even if it did cover more than my own does.

If that weren't bad enough, my new dental insurance doesn't have any coverage for braces. So I owe an additional 400 dollars at the end of my contract now. I asked the benefits coordinator why, and he explained that through their other dental plan (Willamette), braces only cost 400 dollars. Yeah, but they only offer traditional braces, and they have terrible service.

So, I'm panicked. In the next week I have to set up my classroom, get prepared for the first week of classes, pack up my entire apartment, move to a new apartment (possibly unpack?), get my insurance stuff worked out, and.... breathe.

(just breathe).

adjustment today

As I said in my post yesterday, I had a lot of questions going into this appointment. But my orthodontist is so great - he read my mind before I could even ask them!

I will be surgery ready in.... are you ready???? APRIL! However, I can't take time off of school, so surgery will have to wait until June. But what a relief! He also explained what will happen in my next few appointments - the next appointment is a long one, repositioning brackets and getting my first set of stainless steel wires. After that, the focus will be on closing my lower gaps and achieving as much width in my lower arches as possible. He says that while they are working on my upper jaw, it's not as big a priority because it's going to be widened in surgery.

School gets out on June 16th with the 17th-20th being possible snow makeup days. I will probably shoot for the last week in June to give me time to prepare. My mom has a ton of vacaction time, luckily, so she'll be able to come up and take care of me the first week or two (my husband leaves for National Guard training in January, and will be gone for a year to two years in California... with no way to take time off). Thank goodness she'll be able to help - otherwise, things would be scary.

He also gave me a few splints, hoping to curb some of the severe migraines I've been getting lately from my jaw. They're pretty neat - I'll post pictures when I get a chance, and let you know how they work out.

Oh, and the gums? Looking fine. Whatever.

the almost waterpik and why I hate my husband....

Big things are happening in life - in the last week, I got a new job teaching band and orchestra, with a continuing contract to boot so I don't have to interview for jobs next summer with my jaw banded shut and swollen like a cartoon. I think I found us a new apartment (we'll move in next weekend) and we are possibly buying a new car this weekend... Which of course, results in us needing to save our cash flow and not being able to buy a waterpik!!

The gums are still doing terribly... but I have an appointment tomorrow in the early AM so I'm going to talk with them about it. I also need to talk with them about making sure my surgery date is as soon as school gets out, and to talk with them about insurance stuff, since I've got the new job and I don't know how that'll work out.

My husband went into the orthodontist a few weeks ago. We've been noticing that his teeth have been moving quite rapidly, and I noticed his midlines being extremely off - he had braces for a very long time as a teenager, and he wanted to talk with an orthodontist. Just like I suspected, he has a severe cross-bite and needs braces and lower jaw surgery. He doesn't want braces, but the orthodontist is worried about his front teeth shortening because they are hitting together every time he closes his mouth. (P.S. If we ever decide to have kids, poor them. Or poor us, having to shell out all that money for orthodontics).

All things aside, he was able to skip the braces and jaw surgery for now, and got to get these:

I must say I'm jealous. Aren't they pretty? Can't wait to have my own some day.

why I love braces

You know? Seven-ish months into this journey, I love my braces. Here's why.

• They are always a conversation piece.
• They are an excuse to not try a food or a drink I don't want to at a party or social gathering (oh... no thanks, you know, I'd have to go brush afterwards again. thanks anyway!
• They are an excuse to eat frozen yogurt whenever my teeth hurt.
• They are working so quickly and efficiently!
• I have met a whole host of wonderful blogging friends.
• At the end of all of this, I will have a beautiful smile and an even-more beautiful bite!

In other words, while I'm not seeing any changes, I know that they're working in there. My teeth have been hurting quite a bit (randomly) for the past week or two, now. My jaw is very tired all of the time, and it's been giving me vicious headaches. Stupid bite.

Just two weeks ago I had a PERFECT placement to chew food - it was beautiful! I wanted to eat all of the time because so many teeth met together! However, now we're back into a more normal placement - only the outside of my rear-most molars on my right side touch when I bite, and my incisiors on my left side touch at the same time. Well, that's the bite that I chew with, not the bite that has unsurfaced itself. I'm developing quite the overbite! It's really attractive with the large gummy smile and huge braces, let me tell you :) I'm workin it!

Progress picture time! (It's too bad that it's not easier to upload photos. I really have a tough time with it sometimes!)

Look at my overbite! I'll give you two shots of it (one sideways because my photo editor is being a pain in the rear end). It is large. Very, very large. And seeming to keep growing (great). In fact, when I position my jaw where it should be (versus where I'm posturing it to be) I can stick my tounge out at people. Fun times, huh? It doesn't seem like my open bite is getting any worse, though... In fact, it seems to be getting better!!

The arch on my lowers is continuing to widen. It's really a spacious home now for my tounge! My gaps from my extraction are still there - but the one on my right side seems to be closing up quickly lately - hopefully the left one follows suit!

Finally, the uppers. They seem to be doing NOTHING! I was a bit upset at the last wire's lack of teeth moving - especially in the area of my front teeth. I assumed that this wire would kick some butt, though - and it just hasn't. It's changed a little, my arch seems a bit wider, but what I really want to happen is for those front teeth to straighten out. And they're just not. Maybe the next wire will do it - my next appointment is in just a few weeks.

Until next time!

comments

After over 6 months in braces, I am still unsure of how to react to dreaded "braces comments." For instance, I was working at the 'bux a few days ago and some guy came up and in a big voice said "SOOOOOO... How're the BRACES?" And I just laughed nervously and said "fine." (He went on to tell me he had them for a long time, but still).

Or when one of my beloved, amazing coworkers asked me when I'd "have my smile back." It wasn't meant to be rude in any way, but come on! I realize my smile is marred by a pound of pokey steel.

I need to have a list made up in my head of comebacks, I think. I know someone out there has a witty response for "how are the braces doing" or "how are the teeth coming along" etc? I seem to get asked this weekly, at least, and I am always awkward in response.

PS. No posts lately because nothing is going on in my mouth. Lame-0.

first cleaning in braces

I had my first cleaning with braces today - not as pleasant as Katherines, let me tell you. I was nervous going in - my teeth are pretty sensitive, my gums are practically triple the size they're supposed to be, and I don't really like cleanings to begin with.

Well, the technician did as best as she could - which was really good, except for my lip kept getting caught between my braces and her hand or the applicance she was using. And MAN are those teeth sensitive when they are being picked at (and picked and picked at).

She said I was keeping my teeth "super clean." Which I'm glad for - I was really worried that the true reason for my gums being swollen was my lack of teeth-brushing skills. I'm doing everyhing right, except for the slight coffee stains and the weird discoloring between by bottom front two teeth. They gave me a really cool paste to put on before I go to sleep at night (yes, yes, yet another aspect for my nightly cleaning regimine) that should strengthen the enamel and add minerals back into my teeth.

adjustment time

I had an adjustment this afternoon. I got my first set of square (rectangular?) wires, and I am hurting already. It seems like every tooth is throbbing, my head is full of pressure, and the roof of my mouth feels like it's going to crack open.

Wahoo! No pain, no gain.

interview!

I got a call for an interview today. It's Monday morning. Why do I let a little bit of metal on my teeth turn me into a nervous idiot? If they like me, they will look past the braces.

Sometimes I really hate braces. They are able to kill the little self-esteem I have. Every time I smile without thinking, I cringe. I have a big smile - I always have, and I've always loved it - crooked teeth and jaw and everything. Now that it's beneath five pounds of tin it's jarring and disgusting, and once you add in my swollen gums it's atrocious.

Argh.

spring?

I can't believe it's spring outside. It is pouring down rain, it's freezing cold, and the wind is blowing so hard that our lights are flickering on and off. It's June! Come on!

It's been a while since I've updated - too busy, per usual. I've had a lot on my plate - played in a few concerts, conducted a few performances, ran a 5k, flew to Denver to swing dance, caught another terrible cold... The teeth progress has been minimal, but since it's been a while I thought I'd post some progress pictures.

The top teeth look almost exactly the same. My stubborn gums have only gotten worse, and I'm going to talk with my orthodontist again at my next appointment (next Thursday). My arches are continuing to round out, and I can feel the pressure almost every day. The back spaces in my lower arch continue to get smaller. My overbite gets bigger and bigger, however. It's really starting to look pretty funny! But the worse it gets now, the better my bite will be after surgery (right?! Right?!).

Does anyone else have problems with clenching at night? I am a mouth breather, or, was a mouth breather until braces. Now, I wake up with intense headaches because I've clenched the entire night. What brings this on? The ortho gave me a mouthguard, but it hasn't helped. It falls out or gags me at night, which I am especially prone to right now with this killer cold.

Okay, last question - have any of you out there had to change orthodontists? I love mine, but there's a small chance I'm moving to CA at the end of this year - my husband just got a new job. I'm not positive I'm moving with him yet, as I don't want to give up the school-district insurance that pays for my jaw surgeon that I have selected and not some army doctor. I'm not so trusting of the army doctors after my last experiences. Anyway, I was wondering how payment works - I'm paying on my braces now, but how would those payments transfer? Hmm....

Well, I'm off to nurse this cold in bed (I had a 102 degree fever a bit ago!).... it's the last week of school, so I don't have the option to take time off from work.

somedays

Sometimes, I forget I have braces. I'm in a dressing room, with a shirt that might not seem terrible on me (even though I've got a long way to go), and then I smile.

And there's metal. And it literally shocks me.

And that's sad.

no kidding....

I had someone ask me how I expected my middle school students to take me seriously while I had braces on.

Oh, but when confronted that I found her comment to be rude, she said "she didn't mean any harm by it, she was just curious."

Am I a magnet to stupidity? Really?

on and on

It is the end of the school year. In the past week and a half, my choirs (or portions of my choirs) have performed 5 times. Those performances and extra rehearsals, plus a concert of my own on my clarinet, plus a field trip across the state, plus progress reports and may-fails being due, PLUS a cold from hell that continues and continues = Stephanie is unable to blog sometimes. (That's my 7th and 8th grade choirs performing in Leavenworth, WA). They're quite adorable, eh?

The gums are the same. In fact, the gums are worse but I'm ignoring it because that's what the orthodontist told me to do (if you look to the picture on the left, they are my teeth on the top, just to the left of the two front teeth). The gum actually touches metal, where the bracket is connected to my tooth. I have tried everything. Brushing softer, brushing harder, swishing with salt water, using the flouride rinse they gave me, brushing more often, brushing less often.... It seems that the gums want to be swollen, no matter what I try. I just do my best to keep food out of there (which is actually pretty difficult).

The bite, however, is worse than ever. There are days (like today) where only the outsides of a few teeth touch. My lips keep getting trapped in the great void of my overbite, and my braces chop them to bits. Check out this overbite!! While my bite has always been "open," I didn't really have an overbite until just a few weeks ago. It's coming out with a vengence! Lovely.

My arches are really starting to shape up, though, especially on the lower half. My gaps are still pretty wide where the teeth were originally extracted, but they are continually getting smaller as my palate gets wider. I can't believe how rounded and lovely those teeth look - especially those front teeth, which are now pretty much completly straight. Yipee!!

The top teeth and top arch aren't doing too much yet. I can tell the arch has started to grow, and my teeth are looking a little straighter. But really, it's only been 5 or 6 weeks since I got my top braces, so I can't complain too much - especially with the progress of the lowers, which were SO MUCH WORSE. (sorry for the blurry picture... I seem to be unable to take a decent picture of my uppers. I don't know why).

Finally, I have one more picture to show you. I want the world to know that this face does NOT look like a middle schooler. I took a choir to a MS/JH choral contest over the weekend before last, and I had a lady come up and ask me where my director was. I am an adult. And yes, I have braces. And yeah, I'm a young-ish teacher. But in no way, shape, or form do I look between the ages of 12 and 14. Thank you.

Hope you are all doing well!!