hopes are up...

[rootofnewt]

i called AETNA. the skin biopsy at Johns Hopkins is covered, so is the doctor who does it. i just need a referral from my PCP, in addition to the 'script written by my neurologist.

the carpal tunnel splints will be covered, as well.

and my foot orthotics are covered on a case-by-case basis. the ortho surgeon just has to call and say, "YES, these are a medical necessity." and POOF! they'll be covered.

:D

now, i hope this all works out. i was really dreading scrimping for the foot plates.

Comments

[mactavish.livejournal.com]

Yay! :)

Wanna come talk to Blue Cross, next? ;)

[krasota.livejournal.com]

once upon a time, BCBS was wonderful. i didn't need referrals... i didn't have co-pays... i didn't have to pay huge amounts over the cost of a service...

these days... it's EEEEEVIL!

i appealed to the mercy of customer service today. i just asked in my little-girl voice, "are orthotics sometimes covered?" she went on about diabetics, etc. i said "what about in the case of bones being too long? skeletal anomalies? i mean, it's orthotics, or massive painkillers and a wheelchair." at that point, she said it was a case-by-case basis and that my doc would have to call.

yes. i alternate being hard-ass bitch and little girl and ultra-professional woman. one of those usually works. oh, and when all else fails, ask for a manager and turn on the southern charm. ;)

not always, but usually. shall i attack BC for you?

[mactavish.livejournal.com]

I've got a bone deformity in my jaw joint that causes some TMJ pain—not enough to make the surgery (with intentional joint dislocating, grinding down the deformity, re-attaching joint, healing) worthwhile, but some.

But even if I wanted it fixed, I couldn't, as most dental and medical insurance specifically exclude problems with TMJ pain, as the cause is so often elusive, and it's hard to treat. My cause is clear, but still. . . .

A year and a half ago, I went to Stanford Hospital's rheumatology department, with a referral. My insurance at the time (Guardian) required a referral, so I got one. I saw the same resident (it's a teaching hospital) each time I went. Each time, a different supervising physician signed off on the visit. Now Stanford is billing me for all but the first visit, as apparently Guardian won't pay for the doctors for which I didn't have a referral. They view each signing-off supervising physician as a different doctor. AAARGH

It's a full time job just keeping the paperwork straight!

I think that's why I'm having this mood slump, mostly. It's only half that I know I'll have to deal with an illness, the medicines, the medicines' side effects indefinitely. It's also that I don't feel like I have energy to fight insurance companies for the rest of my life.

long saga follows...

[krasota.livejournal.com]

yeah, my TMJD is one of those mild cases (off by a millimeter both sides) that (formerly) caused some of the most severe symptoms--migraines, lockjaw, blackouts/dizziness, ear ringing...

my regular GP thoughti was just having regular migraines... he put me on all sorts of meds... the worst were the ones which dilated the blood vessels. i have low blood pressure... passing out frequently was SO MUCH FUN. and that's also when we discovered my intolerance of most pain meds. i spent my junior and senior years mostly high. :/

finally, i got a headache on a rare visit home. mom saw right away that it was my jaw (her story coming next (; )

at the time, our orthopoedic dental dude was savvy enough to file TMJD under ortho/joint problems. then insurance caught on to savvy docs like him and started excluding TMJD COMPLETELY.

fortunately, after several years of wearing splints (lots of different ones--the lab liked me--my lovely jaw torque let them have money to discover better acrylic polymers), i'm more or less cured. i do have certain triggers--stress, hard/crunchy foods, fellatio, etc... but i haven't had a TMJ migraine in several months. my current insurance excludes TMJ completely.

my mother is less lucky. for 25 years (from the time she was 18-20), she was told that her pain was all in her head. by the time she got to a good doc, she hadn't been able to eat solids for a year, had lots lots of weight, had lost her cartilage disks in both TM joints, and had HOLES in the bones of one joint. she'll be on NSAIDS and pain meds for the rest of her life and will always have her splint. fortunately, her insurance covers TMJD.

my ex's insurance covers her TMJD... and her doc is calling for the surgery. :/ none of the splints have helped and she has horrid, regular migraines. :/

you know... a lot of TMJD cases were caused by orthodontists. they tried to create perfect smiles, neglecting the perfect bite. my ortho actually tried for the perfect bite, but genetics won.

i'm sorry yours is causing you so much trouble. i consider myself lucky that mine is normally okay. and i can tolerate alleve these days, which means i can take two at the first twinge of inflammation and head off a migraine before it starts. right now, i'm stressed over all this insurance biz, so i'm rather clenchy of jaw.

Re: long saga follows...

[mactavish.livejournal.com]

Mine's not causing me much trouble at all, anymore. :)

My migraines were caused by bc pills (which I discovered when the doc suggested I use different birth control until I stopped having regular vomiting with migraines). I can only take Aleve or ibuprofen rarely, as I take Celebrex daily. The TMJ pain is only a tiny thing to put up with compared to yours, or your mom's, or my hands, hip, and knees. . . .

Re: long saga follows...

[absinthea.livejournal.com]

I *knew* that in terms of TMJD your mother and I were similar!! I have very very scanty cartilage in both of my TM's. It makes it a bitch to chew gum (which I rarely do because the pain and immobility are pretty distressing), chewy foods or open my mouth for long periods of time (ie dental visits). Fortunately, my ortho helped it a bit. *whee*

[ashbet]

*doing the good-luck dance*

And, for those who need a laugh, picture me doing a stompy dance around a wishing well, with chicken-feather leggings and big elaborate hair ;)

-- Andi

[absinthea.livejournal.com]

Oh, honey, I hate all things medical-insurance related! That includes most allopathic practitioners and institutions...not the mention the hoops they want you to jump through like a good little trained poodle in a clown suit. Grrrr.
So don't worry krassie...if I ever become a homeopath or a naturopath or a shamanic healer I will cure you for the price of some ass-kicking cooking :) No referrals or bullshit!

*sigh*

So far, I have used herbs to keep alot of my ailments in check...and get my kids to sleep well!

[fluzby.livejournal.com]

Oooh ... That reminds me that I need to find my receipt for the foot orthotics I bought last year in order to deduct them from my taxes.

On a related health care provider note. I recently (2 weeks ago) moved into a new apartment. I'm waiting for two Explanation of Benefit forms from dentist appointments in December in order to claim the rest of my flexible spending money. I call up Cigna and wait on hold for forever to get to a claim agent. It turns out that I can't change my address with Cigna that the request has to come through my employer. That doesn't make much sense to me.

just catching up

[laverick.livejournal.com]

Oops, didn't read ahead enough. :) So glad Aetna agreed to cover those things. I'm sure that's a major load off the shoulders.