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It costs what???!!!


It’s now 2016. I’ve been back in Baltimore for a few years now after I purchased my first home in Canton and rehabbed this living shit out of it. That could be an entirely different blog of insanity, perhaps one day.

I’m dating Gary, my now husband, and casually mention to him that I’ve noticed a little gap between my front 2 teeth. Gary, having had extensive work done on his teeth, tells me I should see his dentist, Dr. M. I make an appointment and meet with Dr. M’s partner, Dr. D. She completes a thorough exam and informs me that my teeth are not properly aligned.

My bottom teeth are angled too far inward, my upper teeth are angled too far outward and my upper jaw sits back too far. My teeth all the way around my mouth touch. Hmmmm…I had no idea that’s not how it was supposed to be. But alas, no. You only want your back teeth to touch, not the front. So, each time I bite down, my front teeth, top & bottom) crash into each other and are loose and have begun to separate under the pressure.

I’m sorry. Do what? My teeth are loose????? I’m not 7. That’s now supposed to happen! But is has; I can wiggle my top 4 center teeth. Teeth mobility is ranked as grade 0 being no movement, up to grade III, which is more than 2mm of mobility. I was definitely a I, possibly a II. Great. So now what?
Dr. D recommends I meet with a maxillofacial surgeon to discuss possible double jaw realignment surgery. Whoa. I thought maybe a nighttime retainer, not someone cutting my face off, rather literally, and moving it forward.

Being the obedient patient, I met with maxillofacial surgeon #1. He confirmed the recommendations and I began to look into things with my insurance. At the time, I was insured via the community behavioral health clinic I worked at in Havre de Grace. Needless to say, we did not have the best insurance.

A few month later, with new insurance through my private practice, I’m referred to the crème de la crème of maxillofacial surgeons, Dr. Z. Now, being a smart man, in my opinion because I deal with health insurance myself, Dr. Z does not take insurance. No biggie, I’ll get reimbursed.

I have my consultation, which was a cool $550 between the appointment and new scans. And he recommended I need:
-          Maxillary Lefort I Osteotomy
-          Bilateral Sagittal Split Osteotomy
-          Genio Hyoid Advancement
-          Malar Augmentation

A maxillary Lefort I Osteotomy, known as a Lefort I, would involve a maxillofacial surgeon detaching my upper jaw from my face, by cutting above my teeth, but under my sinuses and pulling my jaw forward about 10mm. There are 3 variations of the Lefort: Lefort I involve the smallest structures of the face, Lefort II includes the nasal area and III includes the cheeks.




The bilateral sagittal split osteotomy, BSSO, is the most commonly performed jaw surgery. My surgeon would cut my lower jaw, or mandible, off at an angle to avoid severing the nerve that runs along through your jaw and provides feeling to that area of your face. 


A genio hyoid advancement, or a genioglossus advancement, would pull the back part of my tongue forward to increase my ability to breathe and the malar, or cheek, augmentation would ensure I don’t have a sunken face with my jaws being pulled forward.

I was obviously scared but wanted all this corrected. So, Dr. Z’s staff crunches the numbers and I’m given the bill.

$44,650.

Wow.


And that’s just the surgeon’s fees? Really? That doesn’t include the anesthesiologist, the 1-3 nights stay in the hospital, the drugs, nothing else? Well, let’s see how much insurance will reimburse me. You’ll reimburse at 80%? Oh, that’s not so scary now. 80% of the “reasonable, usual and customary” charge?

Side note: the reasonable, usual and customary charge is determined by your insurance company. They, allegedly, gather information of what doctors, hospitals, etc. in your geographic area charge. Sounds easy enough. However, unlike with other aspects of health insurance, there are few, if any, regulations in place for insurance companies when determining what they consider reasonable or usual. Legally, your insurance company must tell you how they gather their data and what the charge is for any procedure. But there is virtually no governing body that requires this data to be updated on any regular basis, hey there inflation, nor what a geographic area can include or not include.

Ok, insurance company, what is your reasonable, usual and customary charge for jaw surgery? $2,500 per jaw? You’re telling me I should be able to find a surgeon who will cut off my face and move it for $5,000 and not $33,500 (they’d only cover the 2 jaws and not the other procedures). I would be reimbursed 80% of $5,000, which would equal $4,000 and not 80% of $33,500, which would have been $26,800.

Are insurance companies really paying that little for this surgery? No wonder more and more doctors are accepting fewer and fewer insurances.

Surgery is back on hold.

     

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