Monday, April 9, 2012

Asian Therapy? - Tai Cheng by Dr. Mark Cheng w/Beachbody

    All I can really say is.... WOW!  Only Day 1 and I am sold on the program.... I was skeptical, actually, because I am used to doing "more" after Insanity, TurboJam, ChaLEAN Extreme, P90X, TurboFire... but with my current situation, I can't get back into those yet. Tai Cheng is beyond amazing and in less than a day it has already surpassed any possible expectations I had.

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Thursday, April 5, 2012

Jaw Surgery & Insurance Coverage: When is Jaw Surgery "Medically Necessary"?

    The short answer is ~ Jaw Surgery is medically necessary when the deformity, malformation, hypoplasia, hyperplasia, occlusion or alignment, etc. creates a situation in which your general ability to FUNCTION is severely impeded.  Insurance companies generally won't pay for jaw surgery if the chief complaint is a cosmetic one -- meaning, if you just aren't happy with your jawline or profile, or you're not happy with some asymmetry in your face, or you're unhappy with SOMETHING involving your jaw and want jaw surgery to fix it, unless there is a medical necessity, expect to pay for surgery out of your own pocket.

This video is basically all of the same information as this blog post, I just felt like giving the info in two formats... well, no, I made the video first then thought a blog post would be a good idea and decided to combine the two since they're basically providing the same info...

How Did You Get Your Insurance to Cover Jaw Surgery?
     I didn't. My health insurance is through the military because I'm married to a U.S. Army officer. My dental insurance is through a separate organization (separate, as in - not the same as my health insurance but still through the Army). My dental insurance would NOT cover braces, which are necessary for jaw surgery. Their reasoning is: Military dependents, including spouses and children, over the age of 23-years, are not covered for orthodontics treatment.  I was 29 when I started braces, this time, so I had to pay for them out of pocket.

    The orthodontist gave me a referral for a jaw surgery consultation. To get my insurance (health, not dental) to cover the consult, I had to submit it to their system. To do this, I took the referral to a medical doctor who entered it into their computer as a regular referral. When the referral was processed, it was flagged by the hospital at Bethesda, MD and I was told I had to go there for my consult. Since I knew that arguing would likely result in a battle for coverage, I simply agreed and was seen at the military hospital - now it's called Walter Reed National Military Medical Center.

   By agreeing to have my surgery performed in a military facility, I never once saw a bill. I will never see a bill. I  had complete, total, 100% coverage for the procedures and no trouble other than having to wait until my jaw was "ready"... since it's a training facility, the teeth/jaws MUST be in the best possible positions to give them the best chance at a safe surgery experience. They won't approve the procedure and authorize/schedule your surgery until then, so I was sent back to my orthodontist 3 times before I finally got a surgery date.

My Insurance Company Said They Don't Think Jaw Surgery is Medically Necessary!!!
    This is VERY COMMON. Jaw surgery is a sort of "gray area" between medical and dental coverage. Dental coverage almost never handles jaw surgery -- so if you're submitting paperwork to your dental insurance company, you're likely barking up the wrong tree.


    Medical/health insurance will cover jaw surgery in many cases BUT the surgery must be seen as a "medical necessity" and NEVER as a cosmetic or elective procedure.


   A friend of mine contacted me recently, frustrated after receiving a letter from her insurance company. They did not view her case as medically necessary for jaw surgery. She'd already had braces on for a long time, and jaw surgery was really the only hope of improving the problems permanently. This is similar to my case - we both had/have open-bites, many of the same complaints and difficulties... she wondered what I would say in response to her insurance company's request for clarification of "difficulty eating" and "dental trauma" ~~ they were explained by the oral surgeon but not to the satisfaction of the insurance company.

   We looked at her symptoms, complaints, and difficulties and listed them out. We then looked at the letter from the insurance company and listed out all the things they specifically wanted to know, from her in her words. She was given 2 weeks to reply but I explained to her that if she took 2 weeks to reply they may view that as not really "important enough" to her. So we got to work right away!

   We also reviewed the insurance company's website, and several other insurance companies' websites, for information regarding what they do cover, what they do NOT cover, and why.


   In the end, we drafted a letter that was a little longer than a page, with spacing between paragraphs to make it easier to read. We kept it short and sweet... to the point... and we avoided using ANY TERMINOLOGY that could possible sound "cosmetic surgery-related".... we NEVER discussed her appearance, self-consciousness that comes from having jaw and teeth problems, asymmetry, jawline, profile... none of it every came up. What we did discuss, however, are the psychological, professional and physical difficulties that arise from having this type of problem.

   A week after sending out her letter, she received the approval from her insurance company! They FINALLY saw why she was saying it was medically necessary.... they finally understood!!  This was so big, and I feel so honored to have been able to help her. Honored that she trusted me and that she felt comfortable relying on me for help. And I was so pleased to hear the good news!

  I will eventually put all of the best suggestions and advice for dealing with stubborn insurance companies up on my Jaw Recovery Playbook site. But since that's such a slow project with all that I've been dealing with, I wanted to put some information up SOMEWHERE to help people now, in the meantime. These tips should help:
  1. For jaw surgery to be "medically necessary" you should avoid mentioning ANYTHING that relates to the cosmetic aspects of the procedures. Those are a side-effect, not a reason for needing surgery.
  2. Review what your insurance company does and does NOT cover by going to their website and checking out the coverage information, and compare that information to correspondence with the company so far. This will help you better understand why they're giving you trouble, if they are. 
  3. Write out a list of everything the insurance company is asking for, specifically, from you.
  4. Write another list of all of your complaints, symptoms, etc. and everything they affect (e.g. work, sleep, health, psychology, ability to care for self, ability to care for children, etc.)
  5. Organize this information in a coherent outline BEFORE writing the letter. This will help you keep it organized and to the point.
  6. When writing the letter, avoid "fluff"... you want things short and sweet, but with sufficient information to present a compelling argument for needing jaw surgery. 
  7. After you've written the letter, read it aloud several times. Anything that's unnecessary or "fluff" remove or change. Your letter should be less than 2 pages.

Monday, April 2, 2012

Returning to "Normal" After Jaw Surgery

     An odd way to start the week, but I have been thinking about this recently and felt it was worth writing on. Tomorrow (Tuesday) marks 16 weeks since I had jaw surgery. On December 13th, 2011 I underwent a 3-piece Le Fort I procedure and genioplasty to adjust and correct and open-bite. Prior to surgery I received orthodontics treatment for 14 months to prepare my "bite" for surgery, essentially making the open-bite worse. I am still wearing braces, but I am almost finished with that treatment as my orthodontist closes any remaining gaps and ensures my teeth become rigid, for lack of a better term, in their new positions.

Obsessing Over Jaw Surgery and Recovery
    We all do it. It's scary. It's important. We're afraid of the worst possible scenarios... prior to surgery and often during recovery, many patients obsess over what's going on with their bodies (or mouths, to be more precise) and they Google, Google, GOOGLE!. I did too. But when I realized most blogs out there are not really helpful, I put more effort into scientific and scholarly research, nutrition, anatomy and physiology, patient psychology, and related research... all of which is being compiled into a major resource website for jaw surgery patients which I've dubbed The Jaw Recovery Playbook.
    During recovery, it's tough. It's really difficult to ignore what's going on, especially when you can't eat properly and you feel limited at every turn. By "properly" I, of course, mean that you can't just pick up a cup, fork or spoon. Most patients are relegated to syringes for at least a couple of weeks. I used syringes for weeks 1-6 but after the major elastics were removed and I could open my teeth a bit I started using a mix of syringes and disposable cake decorating bags which allowed me to have a bit more freedom with food choices.

    Even after my bite splint came out in week 6 I found I just couldn't move past the whole surgery and recovery process. I was still "obsessing" a bit. I made a list of my remaining questions and my surgeon was kind enough to give me a special "bonus" appointment. He answered ALL of my questions and he really took a lot of time to make sure that I felt comfortable and satisfied with my treatment experience. Things like that mean a lot to me...

    After that appointment, I felt excellent. I wasn't obsessing over it anymore because I had the answers I wanted/needed. I didn't have to "wonder" because I "knew"...

Anemia - The Guest That Wouldn't Leave
    The anemia I've been dealing with is related to the blood lost during my surgery. The symptoms were not noticeable at first. During the first 4 weeks or so after surgery, I might feel a little winded or dizzy but I thought that was from having the bite splint in and breathing through my nose most of the time, or from the change in diet. I'd sit down and relax and feel okay.

     In week 5 I attempted 3 workouts. Well, I planned to do 3 but only completed 2. They were only 35 minutes long and they were non-cardio, weight-training workouts. I used light weights, nothing over 12 lbs. Yet, I seriously thought I might die! Okay, maybe not "die" but I felt like I would pass out if I didn't stop after every exercise. Red flags went up because I knew I wasn't in such poor shape to suffer so much from an easy workout, but I ignored the red flags. In week 6 I saw another doctor for my regular exam and she ran bloodwork which showed the anemia.

    When the symptoms didn't improve after a month on iron supplements I went back and was told that it takes 100 to 120 days to replenish the lost hemoglobin. I didn't know that haha...

   Now, at 16 weeks, I am feeling significantly better. Not winded with minimal exertion anymore. A little dizzy still, on occasion, but not like it was. I feel comfortable saying the anemia is likely not a problem right now but I will continue taking the iron supplements because I have a feeling my labwork has always shown lower (though "normal") hemoglobin levels and this might be necessary... for a while at least.

But When Do I Get Back to Normal After Jaw Surgery?
     This depends on the individual, of course. For me, at 16 weeks (4 months) I'm still not 100%. A couple of other things (health-related) have occurred during this time which has sort of slowed my return to normal. When I went back the second time for the anemia my doctor and I discussed my acid-reflux (GERD) which I'd been taking a PPI (proton pump inhibitor) for since 2006 -- over 6 years! They're not meant to be taken that long, but I was told that I would need it for life (?)

    As it turns out, in 80-90% of people diagnosed with acid-reflux, usually before they're in their 30s, the underlying cause isn't actually GERD but an infection with a particularly stubborn bacteria known as Helicobacter Pylori, or H. Pylori for short. My doctor ran two tests for this. There are three types of diagnostic tests they can run, but he ran two blood tests on me; (1) for acute infection and (2) an IgG serum test. The acute test came back negative, but the next day he called me saying the IgG test was positive. After 10 days on 2 types of antibiotics (it's stubborn haha) I should be "cured"... I'll continue my Nexium for 2 weeks then start to wean off it.
   The other thing is an ovarian cyst. Most women get ovarian cysts that come and go, without ever noticing them. This one was apparently noticeable (BIG) and I've been told "no running, no jumping, no twisting" until it's gone, to hopefully prevent it from twisting around the ovary causing what I imagine will be excruciating pain. That sucks though! I mean, I can deal with it.... but I was hoping to start working out again. It's been 4 months :-(  When I can't workout it affects my sleep, my appetite, my overall energy levels....

    So I'm not back to "normal" yet... and it seems I won't be for at least a few more months. So what do I do in the meantime?

Tai Cheng: Tai Chi - Beachbody Style!
    I was hoping to start working out again this week or next but with that cyst and the stipulations placed on me by my doctor, it wasn't going to happen. I saw that Beachbody released the new 90-day Tai Cheng program. When I was younger I did Tai Chi, among other forms of martial arts, and I LOVED it! I looked at the program details... I'm a Health & Fitness Coach with Beachbody so I have access to a lot of material on the different products, and I get a 25% discount :-)

    I made the decision to order it. It's pricey, even with my discount, because I bought the deluxe package, but it's worth it to me. To have SOMETHING I can do in the meantime... a structured program that I'll enjoy... yeah, it was worth it. I should get it this week.

    
     It's a 90-day program, as I mentioned, complete with all the extra stuff you would need for the workouts like the foam rollers (the deluxe package comes with two styles of foam roller), resistance bands (if you use them), the complete workout program schedule, over 30 different workouts, a complete eating guide to help maximize the program, and there's also a bonus disc for improving posture, flexibility and joints called Body Alignment.

Lastly... Adjusting to Your New Face After Jaw Surgery
     I forgot that I wanted to talk about this too. At 16 weeks I am STILL adjusting to the subtle changes in my face from Jaw Surgery. These subtle changes are barely noticeable to people who either don't know me well or who rarely see me, but to my family, close friends, husband... and especially to myself.... these changes are pretty obvious.

     It's important to remember that there's a difference between ADJUSTING and unhappiness. I'm not unhappy with my face or profile, I am simply still adjusting to it.

    That being said... I took this picture today...
    To reduce distortion I set the camera timer instead of holding it and I tried to get a natural picture instead of one where I was deliberately posing for a picture. When I see this... I'm fairly comfortable with what I see. I think that I will notice the changes less and less over time, but at 16 weeks I am probably about 65 to 70% comfortable with the way my face looks... in the sense that, when I pass a mirror, wash my face or apply makeup I'm not looking at or touching my face and thinking it looks or feels weird. Progress.... I suppose.