We have a date! Well maybe.........

So, after a long chat with Dr. T's surgery scheduler, I found that she still does not have quotes back from the hospitals on what the surgery will cost if I end up having to pay for it.

She did however; have a strong knowledge of both hospitals and has every confidence that Parkland will be the less expensive option.  She said Parkland offers "Package" pricing for situations like mine and that is very much discounted.  She also said the Zale only offers a 25% discount off of hospital fees and the rest, (medication, anesthesiologists, supplies, etc), are not included.

With that information, I went ahead and requested that I be put on his schedule for Parkland. Either way, insurance covered or not, I am having the surgery.  So.......

October 6th it is!

The only qualm is......... Parkland has been getting some TERRIBLE press lately...

Things like, hygiene issues, Doctors not washing their hands, or wearing surgical gear outside of the operating rooms. Its been quite the buzz here in Dallas.
 
The good side is, insiders are saying that these are isolated incidents and that the oral surgical suite at Parkland is pristine.  AND now that the microscope is on them, they will DEFINITELY be on their toes and providing TOP NOTCH care.

Anyway, if for some reason BCBS approves my claim and I can get a surgery date at Zale that same week, I will switch, but otherwise, October 6th it is, at Parkland Hospital in Dallas.

Now we just wait to see if it will be lower jaw or double jaw surgery.

Still waiting............

But at least a step closer....

Hurry up and Wait!!

Hurry up and Wait!!

And................. exhale!

I went in to see Dr. Simon today to get a new set of records done in hopes of getting insurance coverage of my surgery.  I was hoping that she would be able to determine if I needed both jaws, or just one jaw repositioned.

The answer?

"I won't be able to tell until I get your new molds back, but feel free to give me a call.... it should take about 2 weeks...."

2 weeks?  Seriously?

And to top it off, the new request won't be sent back to BCBS until the molds are back.  Of course, that IS the best way to get the surgery approved, but for goodness sakes already.. I need some answers...

Patience Janell.... Patience....

Pray.... Breathe.... Pray.... Breathe.....

Or as Julia Roberts did, "Eat, Pray, Love."

I have been praying, relentlessly, and my life is FULL of love, but unfortunately, the anxiety of today caused me to not be able to eat tonight. 

Not sure if it was the build up of excitement to finally get some answers, only to be let down, or if it were the layoffs at work today that has gotten my tummy all in knots, but I can tell you, its definitely not my favorite feeling.

I feel like I'm in limbo on the surgery thing.  I don't have a quote back from the two hospitals so that I can pick one based on if I'm self paying, I have to have the rates before I can schedule a surgery date, AND to top that all off, one of the hospitals in question is Parkland Hospital in Dallas and if you haven't seen the media lately, DON'T LOOK ETHEL!  It will freak you out!

I have really been trying to aim for the first week in October for a surgery date. Q4 at work is really crazy and I want to have this behind me and back at work before mid October. Now, my thoughts are....

2 weeks until the molds gets back.

Then submit to BCBS.

They have 30 days to respond.

That puts us with a surgery date already into the 2nd week in October.

Sharon has a major project launch in Riverside,CA the last weekend in October and we just has such a tight window for both of us.

Again, Pray and breathe.

God's got this!  Dang it if my human brain doesn't try to take over all the time.

I am going to take a hot bath, relax and try to find my patience somewhere in the back of the dresser drawer.  I'm pretty sure that's where I left it.

Phillipians 4:6-7

Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus.

A Glimmer of HOPE!!!

August 22, 2011 – A Glimmer of HOPE!!!

I woke up at 4:30 a.m. this morning thinking about funding this surgery.  It just happened that Sharon was awake and restless at the same time.  Not sure if she was already restless as I was, or if she just didn’t want to admit that I was keeping her awake.  She’s sweet like that.

Anywho, my brain was on money for the surgery and hers was on impeding layoffs at work this week, and neither one of us could sleep. I shared with her my thoughts and immediately she began to pray with me.  In all things we give thanks, and the more we can let go of and give to God, the better off we are.  We know that he is going to take care of us, and this circumstance is no different.

Seemed like we prayed for an hour and finally found some peace.  I know that he will provide so I just have to let go.

After arriving at work, I decided to put a call into our HR Benefits department, just to ask if there was any chance at appealing the denial.  (Thank you Sharon for suggesting that).  I left a voice mail on the benefits line and then received a phone call back from the benefits director.  She said there is a possibility that BCBS will pay for the surgery if we can prove that orthodontic therapy didn’t work to correct my problems.  Correct them?  It has actually made it worse!

She told me to submit again, with very detailed information on how I have been in braces and that due to my recessed jaw, or “micrognathia” as the medical word calls it, that the braces aren’t enough to correct the problem.  She also said to provide any additional details of TMJ that was available, and then call her when it was done, and she would follow up herself with BCBS.

I then looked at our policy outline and not only did I NOT find the exclusion they were referring to, but  found this..

• Treatment of the mouth, jaws and teeth (preauthorization required), including:

·         Diagnostic and surgical procedures to treat temporomandibular joint (TMJ) disorder (appliances not covered)

·         Alteration of the jaw when appliance therapy does not work

Does that not say it should cover me?

Immediately I got on the phone with my OS office and ask her to resubmit.  Dr. T’s office of course didn’t have detailed records because Dr. Simon had all of those. I immediately called Dr. Simon and she said that the records she had were from September of last year prior to going in to braces.  She had me make an appointment this week (Thank you for working me in) to get a full set of records done again.  This should definitely show how much of an overbite I have and how there ain’t amount of brackets and wires going to fix it!

I am also hoping that she can tell me if I need one or both jaws corrected.

Praise God for putting hope back.

I have not stopped praying about this and I’m sure this may be God’s way of providing.

Holding my breath until we hear…………

The Time in NEAR!

Fall it is!

Routine visit with Dr. Simon reveals that October is the month!  It works with me at work, and my mouth is ready. Well, except for this pesky bottom canine that doesn’t want to turn around and behave!  Other than that, we’re ready!

Knowing I had a very tight window, due to when I can take the time off from work, I immediate get on the phone with Dr. T’s office to schedule an appt to see him and get a surgery date.

2 months out was the earliest!  NO WAY!

I, of course panic.  How can I see him on 9/23 and have a surgery date 2 weeks late?

I called Dr. Simon’s office and asked if she could make a phone call to Dr. T. and try to get me in sooner.  Which of course, because she is the most awesome Doctor EVER!  She texted, emailed and called him immediately, and he told her he would handle it!  They are buds like that you know!

We went to S. Padre island and put this behind us for a week.  Vacation was awesome.  I really needed the break. The surgery has consumed me and the forums, the blogs, websites and videos have been an obsession.  I feel like I just can’t get enough information of read enough on the surgery. I keep reading the same things over and over, and yet I still keep looking to find something new.  I have had many surgeries but none have quite been so daunting as this one.

Anyway, I followed up with Dr. T’s office when we got back and his office was able to move me up to 9/9 and the surgery scheduler said she would call the 2 hospitals where Dr. T. is on staff to see what they quote for the procedure to self-pay patients. I told her Dr. T. said around 6K and she said, “Um, well, I think that is just Dr. T’s fees.  I have seen the surgery upwards around 20K.”

Gulp!

Immediately, my heart stops. How on Earth can we pay for this?

You wouldn’t believe the thoughts that went through my head when I heard 20K.  We are really going to spend more on my jaw than we did on either one of our cars? Will they allow me to make payments? Is it really that much? What are we going to do?

Pray Janell.

Pray through it.  God will take care of you.  He always does.

That’s all I have done since I heard that is…..  Pray….. Pray … Pray…..