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Merrida
01-14-2003, 10:44 AM
I cannot open my jaw wide enough to eat. My health insurance won't cover this saying it's a "dental" problem, so my dental insurance gets maxed out within 30 days the beginning of each year. It's like no one wants to take responsibility (insurance-wise) for what this is and how it affects us.

My doctor wrote a letter to help me appeal to my insurance company, stating that I am on an almost whole liquid diet because I cannot chew most solid foods, he lists the infections I get because I drool now (because of how my jaw comes together),...I cannot articulate well, and I speak for a living,...my inability to eat fibrous foods has affected my digestion and my health,...my husband cannot kiss me, I frequently jam my gums with the tooth brush because I cannot open my jaw wide enough to fit the toothbrush in,...

So my venture this year, is going to be trying to appeal to my health insurance to see that this is affecting my entire health.

Does anyone get any luck with this? I feel like health insurance tells me to bill dental insurance. Dental insurance runs its course within a month and I don't "qualify" for further care.

Where exactly do you go from here, when you've run out of money?

Do "the insurance companies" view this as a medical/physical condition, or purely as a "dental" related condition?

What gives?

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Jill J
01-14-2003, 01:27 PM
I have the same problem with eating. The only thing that works for me is to "squish" my food small enough to fit in my mouth. I was losing weight due to not eating, but starving all the time. Hope this helps you. Also in one of the other posts I read about brushing your teeth and hitting them with a toothbrush, I use a childs size toothbrush and it works great. Good Luck

Jill

Elaine
01-14-2003, 04:14 PM
Merrida,
Insurance companies hate to even acknowledge TMJD.Most have a limited amount they will cover, if any. I had a $3000 lifetime maximum and it didn't go far. The three surgeries have basically been out of pocket. At times, I think it was the insurances way of trying to save me from a lifetime of hell, by not covering me. BUT!!! Like others, I found a way to come up with the money, thinking there would be pain relief. NOT!!! I should have saved my money.
As for eating...I have lost close to 30 pounds last year due to not being able to eat right. When you can't eat solid food, food tends to be disgusting and I am guilty of going without eating. I was in so much pain between the TMJD and the back, I just didn't care. Now I feel like maybe...I can get well again. If I get rid of the back pain, TMJD I will deal with although it sucks to be stuck with this condition. I have a hard time deciding which is worse, but the two together are intolerable.
My doctor wrote a letter to the insurance company stating medically neccessary as I couldn't chew anymore. Needless to say they are cold-heartless,
b------, as they denied me. My motto is expect the worst, because then you won't be disappointed when it doesn't happen. Insurance companies are definitely not on our side.
Take care,
Elaine

GenDen
01-14-2003, 05:40 PM
My insurance will not pay for TMJ treatment. However, my medical and dental did pay for diagnosis. My dental paid for the dental diagnosis examination. The medical paid for an MRI for diagnosis. Neither insurance paid for a splint or dental treatment of the TMJ, but my insurance does pay for physical therapy because they bill/code it as myofacial pain. It works best if your provider has a good office person who knows the correct codes to bill. Every bit of coverage helps.

Merrida
01-14-2003, 08:31 PM
Well my primary "concern" here starts off with my needing full mouth dental reconstruction. After a car accident and whiplash, spinal injury, broken bones in my face and various teeth broken off and/or fractured, - all the surgery and drugs and reconstruction (as it started) began,...so the struggles I've been facing have been related to my back, my neck, my face, my teeth, my nose, hips, legs, etc... and within the last 2-3 years I've had incredibly aggressive and overwhelming dental work (and now only have 2 of my own teeth left on my top jaw - they took the rest)... with little regard for my small mouth they've pryed me open, propped me open, and I've had many nasty dental experiences along the way to oral annihilation.

So while this started out being an issue of trying to reconstruct my teeth so I can chew solid food, and my trying to appeal to my health insurance for consideration because of how my "whole person" health has been affected, -- I'm realizing that several of the "symptoms" I thought were not even related, are evidently extremely related to my jaw situation.

I can feel it. I know what I feel. It angers me when it's implied or told directly that my complaints are not valid or not related. I can read all the posts here -- and unless we are all suffering from some bizzare form of mass hysteria because of watching our computer monitors, - I cannot possibly find any other links that would demonstrate how ALL OF US are sharing so many of these physical symptoms,....how much pain and discomfort we're in,... how much our lives are affected (including our private, personal lives),... how many commonalities we all seem to have,... and yet the insurance companies and the AMA are trying to deny that this even exists?? Or deny that it's a medical condition?? Or deny that there's any association between our TMJ and other bodily ailments?? Or deny coverage of benefits -- because -- because why? Just "who" do "they" think "IS" the responsible party then?

Is it considered a medical issue?

Is it considered a dental issue?

No one wants to lay claim to what TYPE of issue this is, as long as they can continue to pass the buck.

Elaine
01-14-2003, 11:32 PM
Merrrida,
I tried to get it through as a medical condition after all else failed. When it got to the point I couldn't eat right, I figured they would ok it as medically neccessary. Same joint and they wouldn't budge. It is all crap but not a whole lot you can do about it. So many different things have been approached trying to get this condition approved by insurance. Needless to say, most don't get anywhere. Very discouraging... :(
Elaine

thisstarr
01-15-2003, 05:43 AM
Hi Everyone,

I just wanted to put my two cents in.. It is so unfair that even when it comes to the point where we CAN NOT EAT ANYTHING they still wont cover us! I just dont understand why? You have to eat food to live, stay healthy, "health insurance companys" promote staying healthly, get regular check up..blah..blah...blah.. but when it comes to the point where we are drinking all of our lovely food groups they dont care!

This really frightens me because I am only 23 and this hole month I havent been able to eat anymore! I have been eating applesauce and drinking smoothes like crazy, I am so hungery having pains in my tummy and I get so nasusaed everyday from my tmj and it has been worse since I cant eat! If I even put something to hard to chew I am in tears in seconds...My boyfriend said his next payday he was going to help me out and get me some health insurance, I have been trying to get some for a while but I havent been able to work much! Whats the uses of getting health insurance if they wont even cover the most important joint/part you need on your body! They will cover ingrown toe nails but they wont cover the most important part of your body! If one of those damm CEO suffer like us they would change there mind real quick! (sorry had to vent alittle....)

take care,
Starr

Merrida
01-15-2003, 01:38 PM
Exactly! Isn't this the strangest thing though? They cover open heart surgery, bypass surgery, they will even cover gastric bypass if it can be deemed medically necessary -- but they won't cover THIS? They won't help when here we are trying to stay healthy and eat right so we DON'T get cost them loads of money on the back end,... and they don't budge.

Who do we complain to about this to get some changes instituted?

I realize from a legal standpoint -- and this is something that Elaine understands quite well -- business is made through treatment, not through curing. It is in the charter, for example, in the American Cancer Society that if a cure is found, they're out of business. Poof. Gone. Buh-byes. So you see, it behooves them to continually find new ways to TREAT cancer and its symptoms, but it does NOT behoove them to actually find a cure OR is there any benefit in educating us in how to prevent it. The money is made in the pharmaceutical industry to come out with a variety of drugs for each and every symptom associated with cancer, each and every symptom associated with the TREATMENT OF the cancer, and each and every symptom associated with the dying process.

We've become an obese society bent on the immediate gratification of fast foods that are high in sugars and fats all in the name of convenience, .... a society in want of the magic pill to make us happy, make us skinny, make the pain stop, and alleviate us of our responsibility to take care of our selves and our help.

The insurance company loves this. They want us to get fat, out of shape, and self-indulgent. They love it because then they can treat us and treat us for decades for all the health problems we'll develop as a result of this.

But then there's people like us here who are trying to head off further surgeries, trying to eat normal foods so we can be healthy, save the insurance companies money they'd have to pay out in the cost of operations and years worth of therapy and medications. We can save them money in the long run by tending things now,...but they don't want to hear it.

I just don't get it!

I mean, I "do" get it because from a business standpoint it will turn over a bigger profit to keep us sick and in the hospital and keep the contracts they have with the doctors active and fruitful... it won't turn a profit if we all suddenly take responsibility for our own health, eat healthy, develop healthy habits, take care of ourselves, and rely less on medicine, insurance, surgery, drugs,... then the insurance companies go out of business.

They're not IN the business of helping us stay healthy and saving money. They're IN the business of TREATING sick people. No sick people, no money. No broken body parts, no money.

This bites.

I just wish "I" could.

Wil
01-15-2003, 08:39 PM
Merrida:

This sounds outrageous that so many people suffer and go without eating, perhaps you might send this link and topic to John Stossel at ABC News. Go to the news website and email them for national coverage. Try all teh news mags, just a suggestion and producers look for this type of story to cover. I sense they might respond and look at it closely. It might be worth a try. Good Luck, Wil

Elaine
01-17-2003, 12:06 AM
Be assured that talk show people, producers, whatever are only allowed to air certain parts. They will never allow anything that they can get sued over. I know of some that have got into the media and they had to watch what they said. Of course this was to do, mainly with implant victims.
I can't understand why this has been allowed to happen to anybody. Insurance does not make sense, as eating is a medical neccessity. If you can't eat, eventually you're going to die. I have fought this mess for 18 years and I am no farther ahead than I was back then. The only good thing is I am more educated but as far as a solution?? Ugggghhhhh!
Elaine

Wil
01-17-2003, 09:27 AM
Hi Elaine:

I enjoy watching the newsmags and its no secret that Human Interest stories garner the highest ratings. I remember watching a segment about the sleeziness of Insurers with Long Term Disability and how they would cut people off just to save money. As part of the segment, people were profiled and after the show aired, the insurance company changed the status immediately due to the bad publicity. With all the Enron type issues affecting corporate america, companies struggle to become 'An Employer of Choice'

Additionally, the competition is fierce for new and different Human Interest themes and horrendous injustices and I have a strong sense this could be one of them. Imagine a segment based on Merrida's experience, starting with a car accident. If it were me, I would stop at nothing and email everyone and any correspondent who has any airtime at all. There are no coincidences in the world in my opinion. It might be that an email on this lands on the desk of a producer drinking soup due to the same issue. Why do you think every correspondent/newsmag provide their email addresses, its because they want to know about human interest suffering.
One more example of this was the sniper in VA. A reporter was discussing the horrors of what people were facing, and while she was hoping he would be caught, a part of her wished it to continue cause it was good for the ratings. Sick I know, but thats human nature. Maybe someone reading this has time and good organizational ability and will try it. If I couldnt eat and suffering, you can bet I would try anything and everything. Thanks for listening to me vent, and I have been reading your posts and hope my posting finds you healing and in better spirits.

Wil

[This message has been edited by Wil (edited 01-17-2003).]

Autumn Angel
01-17-2003, 12:09 PM
This is so sad isnt it? I just went through 12 years of this medical/dental battle with mine untill last September when I went in to have 2 teeth pulled and they told me (which I was told before) that my jaw surgery and treatment was not cosmetic and would be covered. Only to find out the surgery itself is covered by my medical plan (OHIP) but the Initial dental visit wasnt it cost me 200.00 to find out what I already knew. I am on a waiting list for an arthroscopy which they make 2 slits in front of the ear and put my disk back where it should be, flush the joint and then inject a steriod followed by months of physical therapy. Then they tell me my follow up visits arent covered at 45 bucks a pop and I have to see him 1 week, 3 weeks, 7 weeks and 12 weeks after surgery. I have an excessively long condyle which they say is a birth deffect so wouldnt that be considered medical?? The system dances around TMJD like no one wants it or to treat it without it costing a fortune. My bite is a 24 and he said a "normal" bite is a 50. I am getting so discouraged like many others are from having to live basiclly on liquids and soft stuff and narcotic pain meds because 9 of the 12 years were spent on NSAIDS that ruined my stomach and I ended up on a lifetime supply of Losec that is also 200.00 for a script for a month. Maybe if we all protest it might help lol I have to laugh because its so wrong and so sad. I hope you find relief soon.


------------------
Cheers...Autumn
Female...42
TMJD for 12 years
Carpal Tunnel syndrome
Anxiety/Panic Attacks (cured now I think)
Teen daughters that have had medical problems and I will help and over advice on what areas I am knowledgable in.
Hysterectomy in 2002 due to endometrial bleeding.
Hernia repair in 98.

Elaine
01-17-2003, 02:17 PM
Wil,
I agree, get it all out in the open...It is just not that easy. I am in a group that has tried everything that they can think of possible, so far they have gotten nowhere. Interviewed on TV, health magazine,(I have the write up) only the parts they felt was safe to print were printed. This TMJ issue is very real but for some reason, not recognized. I saw a talk show on Good Morning America, it didn't seeem to mention to much about what really goes on, mostly jaw pain while eating...Ha!
Merrida and I could be a team!!! I was broadsided by someone going 70 miles an hour. Whiplash, cervical spine strain which developed into full blown spine problems. Three TMJ surgeries, loose implant, two back fusions, daily headaches, puking migraines, have lost 30 pounds this year due to not being able to eat. I can't eat and I am damn well suffering. There aren't too many things I haven't tried to help myself, but to no avail. The damage has been done because of the useless surgeries that are STILL being allowed to be done everyday. I heard of one talk show that got sued because too much was allowed to be told on their show. Still it didn't make a difference. Again, I am mostly talking implant issues. If the screwed up implant patients can't get recognition, how is anybody else going to?
I am healing, thanks....Tomorrow I will be in better spirits....What a difference a day makes in the life of a sufferer.
Elaine
Thanks for listening to ME vent!

Autumn Angel
01-17-2003, 11:31 PM
Hi Elaine I just wanted to say I hope you feel better and vent anytime. You have gone the extra mile it sounds on the behalf of all of us TMJD sufferers (sp?). And I for one thank you and apriciate you. I cant spell though. lol.

------------------
Cheers...Autumn
Female...42
TMJD for 12 years
Carpal Tunnel syndrome
Anxiety/Panic Attacks (cured now I think)
Teen daughters that have had medical problems and I will help and over advice on what areas I am knowledgable in.
Hysterectomy in 2002 due to endometrial bleeding.
Hernia repair in 98.

autumn83175
01-18-2003, 02:23 AM
I don't know if this will be of any help to any of you, you may have already done this. Start writing letters to governors, councilmen, senators etc. In New Jersey, the government was overwhelmed with letters, they are now working on a law which madates heatlh insurance providers to cover TMJ. Most small business health policies are already now required to cover TMJ, excluding braces. Contact your state insurance commissioner. They may be able to help point out some companies that cover TMJ and help you with your appeals process if you are declined. File complaints against the insurance company. They respond to the state more seriously then they respond to you. If you do these things, they may not help your immediate situation, but they may help someone else down the line to keep from going through all the aggravation we have. Also, see my posting to Starr in her HMO/PPO posting for more info on how the crooks in the insurance companies operate... Hope this helps!

Libby353
01-22-2003, 05:52 PM
Originally posted by autumn83175:
Start writing letters to governors, councilmen, senators etc. In New Jersey, the government was overwhelmed with letters, they are now working on a law which madates heatlh insurance providers to cover TMJ. Most small business health policies are already now required to cover TMJ, excluding braces. Contact your state insurance commissioner.

I totally agree here. My doctor tries his best to get coverage passed here in NY and also appears before Congress and does speaches on TMJ Disorders trying to get more coverage for people suffering like us. The more pressure you put on the insurance companies the better. I know sometimes it looks hopeless, but it is the only way to get them to realize we need this insurance. Also, I have had much success with guided imagery and relaxation therapy over the past few years dealing with my TMJ, CFS and hypoglycemia. I also had a very bad car accident almost 10 years ago and had to have my shoulder repaired from it. I used guided imagery to help with the pain and healing after surgery and was back at work within 10 days. I use it all the time and it does help very much with the TMJ pain and alignment of the jaw. You should check it out.





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