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…………
