Lori Lynn
06-11-2003, 02:32 PM
I'm so annoyed right now.
I had an appointment with my OS scheduled for July 3rd, and had to postpone it. The next nearest date they can see me is SEPTEMBER 4! :eek:
I think it's time to (1)write a nasty letter to my insurance company, and (2) find a new doctor. I've been trying to get treated by this guy since late January, didn't have my first appointment until March, and have only seen him twice. My splint was made by another dentist for this guy, but was never adjusted in the month and a half I've had it. The best part is seeing all the commercials saying how wonderful this insurance company's coverage is, how they do more for their patients than anyone else. Ha.
Anyone have any luck getting an insurance company to cover out of network doctors? This guy seems to be their only TMJ guy, and not only is he way overbooked, but it's two hours away from my home.
I had an appointment with my OS scheduled for July 3rd, and had to postpone it. The next nearest date they can see me is SEPTEMBER 4! :eek:
I think it's time to (1)write a nasty letter to my insurance company, and (2) find a new doctor. I've been trying to get treated by this guy since late January, didn't have my first appointment until March, and have only seen him twice. My splint was made by another dentist for this guy, but was never adjusted in the month and a half I've had it. The best part is seeing all the commercials saying how wonderful this insurance company's coverage is, how they do more for their patients than anyone else. Ha.
Anyone have any luck getting an insurance company to cover out of network doctors? This guy seems to be their only TMJ guy, and not only is he way overbooked, but it's two hours away from my home.
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shell389
06-11-2003, 02:46 PM
Lori, It is really hard to get insurance to pay out of network. Usually has to be a very extenuating circumstance. If you told them about the unavailability of appts. I guess it's possible they would make an exception but not too likely. You could always try though.
I live in PA too and have a dentist I am treating with that specializes in TMJD and maxo. and oral facial pain. I noticed it says you are near the Poconos. I am about 2 hours from there and the dentist I see would be even closer. But he is probably not in your insurance network. I don't think he participates with any insurances.
Hope you can get an appt. sooner than September. Let me know if you want the name of my dentist. His is listed on the American Academy for Craniofacial Pain.
Shell
I live in PA too and have a dentist I am treating with that specializes in TMJD and maxo. and oral facial pain. I noticed it says you are near the Poconos. I am about 2 hours from there and the dentist I see would be even closer. But he is probably not in your insurance network. I don't think he participates with any insurances.
Hope you can get an appt. sooner than September. Let me know if you want the name of my dentist. His is listed on the American Academy for Craniofacial Pain.
Shell
TiffanyAnn
06-11-2003, 03:36 PM
Hi:
I just had a thought...perhaps if the diagnosis code was given as MPD instead of TMJ maybe your insurance company might be more inclined to pay for your treatment. No assurances of course but worth a try maybe.
Tiffany
I just had a thought...perhaps if the diagnosis code was given as MPD instead of TMJ maybe your insurance company might be more inclined to pay for your treatment. No assurances of course but worth a try maybe.
Tiffany
Lori Lynn
06-11-2003, 03:49 PM
Thanks Shell & Tiffany!
There are some promising looking docs on the AACP site. Allentown isn't any further than where I'm going now, and would probably take less time with the turnpike. :D
My insurance does cover TMJ treatment. They covered half my splint, which was nice. But it has to be from one of their doctors, and they seem to only have ONE, who is obviously very overbooked. I'll give complaining a try... it can't hurt. :D The worst that will happen is I'll have to pay out of pocket. If I don't try, I'll have to do that anyway. I have some friends who worked for insurance companies giving me some pointers. I'll let y'all know how it turns out.
There are some promising looking docs on the AACP site. Allentown isn't any further than where I'm going now, and would probably take less time with the turnpike. :D
My insurance does cover TMJ treatment. They covered half my splint, which was nice. But it has to be from one of their doctors, and they seem to only have ONE, who is obviously very overbooked. I'll give complaining a try... it can't hurt. :D The worst that will happen is I'll have to pay out of pocket. If I don't try, I'll have to do that anyway. I have some friends who worked for insurance companies giving me some pointers. I'll let y'all know how it turns out.
CherylLynn24
06-11-2003, 11:51 PM
Lori,
WOW!!! September is a loooong time to wait. From what I understand, a splint needs to be adjusted at least once a month, if not more. If that's the best that his office can do, (September) I think that I'd start looking around for someone new.
Most of the specialists/dentists that my Son sees are out of network, but our insurance pays 70% of those compared to the in network. The claims are always sent in as Myofacial Pain Dysfunction, (as Tiffany said) and a larger amount is paid out than if it were sent in under TMJ. MPD is considered a medical condition, that's probably why. Let us know what you chose to do, and Good Luck,
Cheryl
WOW!!! September is a loooong time to wait. From what I understand, a splint needs to be adjusted at least once a month, if not more. If that's the best that his office can do, (September) I think that I'd start looking around for someone new.
Most of the specialists/dentists that my Son sees are out of network, but our insurance pays 70% of those compared to the in network. The claims are always sent in as Myofacial Pain Dysfunction, (as Tiffany said) and a larger amount is paid out than if it were sent in under TMJ. MPD is considered a medical condition, that's probably why. Let us know what you chose to do, and Good Luck,
Cheryl
Lori Lynn
06-16-2003, 10:51 PM
I have some good news. :D
I had to see my regular doctor today for an ear infection (which I'm very glad it was an ear infection -- I was afraid it was my jaw getting worse), and told her about my problems with the OS. I found out that a new OS in my insurance group just came to my local area in the past week or so, and she's pretty sure he treats TMJ. They're going to see about setting up an appointment in the next two weeks.
In odd news, my doctor reviewed the readings of my MRI, and it said it was normal. I don't think there's any way it can possibly be normal, with all the clunking and grinding noises going on in there. I'm loose-jointed all over -- I've had dislocated a number of joints in my life -- and it feels like my jaw is popping out of joint if I open more than a teensy bit. My OS did say that the people reading them don't always know what to look for, though.
I had to see my regular doctor today for an ear infection (which I'm very glad it was an ear infection -- I was afraid it was my jaw getting worse), and told her about my problems with the OS. I found out that a new OS in my insurance group just came to my local area in the past week or so, and she's pretty sure he treats TMJ. They're going to see about setting up an appointment in the next two weeks.
In odd news, my doctor reviewed the readings of my MRI, and it said it was normal. I don't think there's any way it can possibly be normal, with all the clunking and grinding noises going on in there. I'm loose-jointed all over -- I've had dislocated a number of joints in my life -- and it feels like my jaw is popping out of joint if I open more than a teensy bit. My OS did say that the people reading them don't always know what to look for, though.
shell389
06-16-2003, 11:30 PM
Lori,
Glad to hear you can get a sooner appt. It is not fun at all waiting around when you are in pain.
Hopefully the new OS will be able to better read the MRI for you and figure out what is going on.
Take care, Shell
Glad to hear you can get a sooner appt. It is not fun at all waiting around when you are in pain.
Hopefully the new OS will be able to better read the MRI for you and figure out what is going on.
Take care, Shell
Lori Lynn
08-08-2003, 02:49 PM
I wanted to post an update to my story, and give people some hope and inspiration.
I went to the new oral surgeon, who was a really nice guy, but not helpful in the least. He told me I had a slightly displaced disc, but said that my problems were because I was a "type A personality" (I'm not. I'm a sloth!), and "That's just the way God made you." He suggested I see a neurologist for biofeedback and stress management. It wasn't until I got home that I started getting flaming mad. The only "stress" in my life is dealing with constant pain and doctors! ;)
He also wasn't able to adjust my splint, and suggested I either make an appointment with the dentist who made it (which is about 2 hours away) or have my regular dentist adjust it.
Since I was sick to death of getting the run-around from all the doctors in my insurance group, I opted to see my regular dentist.
He's not a TMJ specialist, but from what I've read on here about specialists, he probably could be, as he has gone to several courses about it. He took one look at my splint, with all kinds of bite marks all over it, and told me that it wasn't doing me any good at all. At this point, I'd had the splint about 3 months, with no adjustments at all. I was taking 600mg of ibuprophens every six hours like clockwork, both for pain in my jaw itself and pounding headaches.
My dentist took about 45 minutes to adjust the splint, checking the bite constantly, and had me try it for a week.
The first few days, it felt kind of strange, like when you get your braces adjusted, but by the fourth day, I realized around 4 pm that I hadn't taken ibuprophens all day! While my jaw was a little stiff feeling, I didn't have a pounding headache. :D
It's now been a little over a week, and I had my second adjustment. I can get by taking pain pills about once a day now. I can sleep through the night without muscle relaxants most nights. I'm not 100% yet, but amazing and inspired by the difference, and the dedication and caring nature of this dentist.
Like my dentist told me, "I'm not a specialist by any means, but I have one thing a lot of these oral surgeons don't have... and that's patience."
I could add, "and a heart," to that quote. :D
I went to the new oral surgeon, who was a really nice guy, but not helpful in the least. He told me I had a slightly displaced disc, but said that my problems were because I was a "type A personality" (I'm not. I'm a sloth!), and "That's just the way God made you." He suggested I see a neurologist for biofeedback and stress management. It wasn't until I got home that I started getting flaming mad. The only "stress" in my life is dealing with constant pain and doctors! ;)
He also wasn't able to adjust my splint, and suggested I either make an appointment with the dentist who made it (which is about 2 hours away) or have my regular dentist adjust it.
Since I was sick to death of getting the run-around from all the doctors in my insurance group, I opted to see my regular dentist.
He's not a TMJ specialist, but from what I've read on here about specialists, he probably could be, as he has gone to several courses about it. He took one look at my splint, with all kinds of bite marks all over it, and told me that it wasn't doing me any good at all. At this point, I'd had the splint about 3 months, with no adjustments at all. I was taking 600mg of ibuprophens every six hours like clockwork, both for pain in my jaw itself and pounding headaches.
My dentist took about 45 minutes to adjust the splint, checking the bite constantly, and had me try it for a week.
The first few days, it felt kind of strange, like when you get your braces adjusted, but by the fourth day, I realized around 4 pm that I hadn't taken ibuprophens all day! While my jaw was a little stiff feeling, I didn't have a pounding headache. :D
It's now been a little over a week, and I had my second adjustment. I can get by taking pain pills about once a day now. I can sleep through the night without muscle relaxants most nights. I'm not 100% yet, but amazing and inspired by the difference, and the dedication and caring nature of this dentist.
Like my dentist told me, "I'm not a specialist by any means, but I have one thing a lot of these oral surgeons don't have... and that's patience."
I could add, "and a heart," to that quote. :D
CherylLynn24
08-08-2003, 02:53 PM
Lori Lynn,
Good for you, it sounds like you've found someone willing to take the time with you!!! I hope you continue to see improvement.
Cheryl
Good for you, it sounds like you've found someone willing to take the time with you!!! I hope you continue to see improvement.
Cheryl
RobynRose
08-08-2003, 08:19 PM
Hi Lori Lynn... First, I'm so happy for you ...
I just read this thread for the first time... I relate a lot to the way you feel youro jaw is behaving. You mentioned being loose all over - this is exactly how I am, and I know what you mean about feeling your jaw is now behaving like many of the other joints that pop - or subluxate. Have they told you that you are hypermobile because of loose ligaments?? I hope for you that this dentist (with the patience) can help figure out exactly what will quiet down the tmj problem. What type of splint is it you are using?? I just got my neuromuscular splint last week. It's been a bit diffiuclt to adjust to wearing it 24/7 - and I still can't eat with it. I am still popping and cracking with the splint in... guess it will need more time. I could accept the noises if the pain could be managed.
Anyway...just wanted to say hi and wish you luck. Keep us posted.
:) RobynR
I just read this thread for the first time... I relate a lot to the way you feel youro jaw is behaving. You mentioned being loose all over - this is exactly how I am, and I know what you mean about feeling your jaw is now behaving like many of the other joints that pop - or subluxate. Have they told you that you are hypermobile because of loose ligaments?? I hope for you that this dentist (with the patience) can help figure out exactly what will quiet down the tmj problem. What type of splint is it you are using?? I just got my neuromuscular splint last week. It's been a bit diffiuclt to adjust to wearing it 24/7 - and I still can't eat with it. I am still popping and cracking with the splint in... guess it will need more time. I could accept the noises if the pain could be managed.
Anyway...just wanted to say hi and wish you luck. Keep us posted.
:) RobynR
Arleen
08-08-2003, 10:36 PM
Hi Lori Lynn:
I so pleased that you've finally found someone to properly adjust your splint and that you're seeing improvement. Sure is a hard thing finding a dentist with patient and a heart...and who knows what they're doing!! :)
When I saw the topic title "more than 2 months," on the board today, I thought sure you were talking directly to me! I was told by a neuro today that it would take at least 2 months to get a splint made for me. Two months seems like forever, especially since my symptoms get worse by the day.
Maybe I'll get lucky like you! :) Keep us informed on how you're doing.
Take care,
Arleen
I so pleased that you've finally found someone to properly adjust your splint and that you're seeing improvement. Sure is a hard thing finding a dentist with patient and a heart...and who knows what they're doing!! :)
When I saw the topic title "more than 2 months," on the board today, I thought sure you were talking directly to me! I was told by a neuro today that it would take at least 2 months to get a splint made for me. Two months seems like forever, especially since my symptoms get worse by the day.
Maybe I'll get lucky like you! :) Keep us informed on how you're doing.
Take care,
Arleen
mdla
08-08-2003, 11:19 PM
Lori Lynn,
Dont you love these TMJ "specalitsts" who can see you have a physical problem on film yet they dismiss your pain as being caused by mental things. They've tried me on every anti-depressant and said to go to costly bio-feedback session etc. Why do they refuse to look at the physical? is it because so many TMJ surgeries have failed that they really don't know what to do with us so they figure some doctor should be making money if not them? Jeez
Dont you love these TMJ "specalitsts" who can see you have a physical problem on film yet they dismiss your pain as being caused by mental things. They've tried me on every anti-depressant and said to go to costly bio-feedback session etc. Why do they refuse to look at the physical? is it because so many TMJ surgeries have failed that they really don't know what to do with us so they figure some doctor should be making money if not them? Jeez