Sunday, July 1, 2012

5 A Battle with the Insurance Comapny won, and a year later

It has been over 2 years since my last post, but the treatment has all been completed.

I will try to describe the events in as brief a story as possible.

July 2010: 

Dr. Schendel and his recommended orthodontist came up with a treatment plan that included the compaction of my right upper teeth, slanting of more right side teeth, all around the already underlying discovered jaw problem in order to get the gap to close.

While, this may be a solution to setting my misguided right jaw placed in the socket, the implications included a further rotation of the jaw (which is already unpleasing noticeable), worsens the misalignment between my centerlines, but more basically, it does not fix the underlying problem, but rather "camouflages" it in a rather unrefined manner.

I have refused this treatment.

August 2010:

 Since then I have consulted with a different surgeon, Dr. Alexander Hoghooghi and his surgical partner Dr. Sabine Girod at the Palo Alto Maxillofacial and Oral Surgery clinic, associated with Stanford Hospital. Dr. Hoghooghi took one look at me and immediately gave me a preliminary treatment plan which included balancing out my upper jaw, and rotating my lower jaw to fit, AFTER orthodontics has set my upper and lower teeth nice and straight relatively to the individual jaws.

This implies as the braces go on, the worse my bite gets, and then they fix they underlying jaw mis-development. This is exactly what I was looking for.

August 2010 - August 2011 (approximate).

This has been the one of the most frustrating years relating to the treatment. Dr. Hoghooghi has sent my insurance company, CIGNA, a letter requestiong pre-approval of the procedures, so I am not left with a denied bill of $31,500 afterwards. CIGNA has declined to pay, indicating there is no medical necessity. I could not have been more furious.

The next year was spent appealing, reappealing, and finally scheduling a conference call with the insurance company, the surgeon, and myself. The surgical team has put in countless efforts to help me get this approved.

The morning of the conference call, I get a call from CIGNA saying they have canceled the call, and the head reviewer has approved all procedures.

 Once the approval letter was received, the next phase began.

September 2011 - August 2012

Orthodontics. Total treatment cost: $8000. Insurance lifetime coverage on my policy: $2000.

Financed over 2 years, that's affordable.

The orthondotist's name is Dr. Nahal Ashouri located at the El Camino Hopsital grounds in Mountain View, CA. From what I have learned about her, she is one of the minority 5% of dentists with a surgical certification. I could not feel any more comfortable with a dentist. After looking at my (now expired) C-Dental X-rays, she had me take some new ones, and came up with a full treatment plan.

As mentioned briefly, then plan involves moving all my teeth back into their proper positions relative to each individual jaw. So, since my jaws are misaligned, my teeth will now also not close properly, and the idea is to move the jaws around a proper bite, so that the jaws are also properly rested.

This phase would end in August 2012.




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