Hi guys. I had this whole post written and then I accidentally closed out of it. So, here it goes again. My surgeon turned the pre-certification for my surgery in the 14th of April. Starting towards the end of the month I called everyday. Finally on May 2nd, a nice lady answered and helped me figure out what was going on. Turned out no one had looked at it yet, so she took it up to the medical review people and put a rush on it. I called everyday again until yesterday when someone told me what I consider some of the worst news I've heard in a really long time.
As it turns out, I didn't even need to hand in a pre-certification for this surgery since it is considered outpatient. They did tell me however that my insurance policy has a TMJ clause stating that my lifetime benefits can not exceed two thousand dollars.
I thought that this surgery fell under major medical, or something. I was shocked to hear this. I had never prepared myself for this- I thought that since there is a law in Georgia stating that an insurance company cannot deny a TMJ treatment if it is medically necessary, I was completely covered and everything was fine. They told me they were not denying that my surgery was medically neccesary, they were just only going to pay for two thousand dollars of it. So, of course, I had no idea what I was going to do.
I talked it over with my husband and family after crying for several hours thinking that my one chance at feeling better had failed. Things got better today though. My Dad called and said that he would pay for all of it. I'm so lucky to have a father that is able and willing to help me out so much. When this surgery works, my husband and I will be forever indebted to him for making my life happy and pain free. Hopefully sometime soon we can start paying him back.
Anyway for those of you who aren't familiar with how much TMJ surgery costs, I'll give you a rundown of the cost of my arthroplasty.
Surgeon fees: $6,867 for one side. I'm doing both
Hospital fees: $8-10,000. This is obviously an
estimate. Different things factor into this
such as how long I stay, what medicine and care
I requre, etc. I am booking a 23 hour stay.
Anesthesiologist fees: Approx. $1500. I haven't talked
to anyone about the cost of this, but have heard
this is about how much.
***GRAND TOTAL*** $25,234.
I am scheduled for my pre-op appointment Tuesday.
I have a plane ticket anywhere in the U.S. so I am going to go away for a couple days before I have it to clear my head and have fun. So, we're shooting for the 2nd of June depending on the hospitals availibility.
That's my story for now. One word of advice for those of you who are or could be in my situation: make sure you consider what could happen if insurance does not pay for your surgery. Make sure you consider all possibilities for everything that could go wrong.
I know it sounds so simple, and that you would think of it...maybe most people do and I was just naive in thinking everything would go ok.
In any case, my family and I are crossing our fingers that this will be a successful surgery.
Hope you guys are all doing great and having a pain-free night.
"love all, trust a few, do wrong to none."
Oh my gosh that is so much money. I wish you the best for your surgery. Okay, I am pretty new to the board, I do more reading then writing at this point. I, after 10 dentists was told I have TMJ. I have almost every symptom on the list... grr. Okay, Stacy, can I ask a couple of questions? How long have you been in pain with your TMJ? Did you ever try splints or orthoics? If so, how long, if not why? I am currently working with a nueromuscular dentist who is fitting me with a orthoic and he better hurry as my nightguard is no longer working... :-( He gave me a Tens unit made by mytronics, it is completely different then other tens units, I wanted to get one for myself and thought I would find one cheaper but they are the only ones making the unit specifically for TMJ and they want $800.00 for the unit. it has 3 leads, one is a ground that is put on the back of you neck, at the hairline and the other two on each face cheek, close to my ears and then I am strapped to this thing for 2 hours. I can not tell you the relief I am getting from this unit. Anyway,I can get gabby on the keyboard, please forgive. I guess the reason why I ask these questions, am I so concerned about going through all of these steps, to only come out on the other side still needing surgery. :-( I put $4,000 into my mouth last October, from a periodontist, that did not work and now the orthoic is about 4,600.00 We have no insurance, but from the sounds of it, they wouldn't pay anyway. So can you give me a brief history?
[This message has been edited by DianeTMJ (edited 08-04-2003).]
Holy Cow, I thought we'd spent some money!! Love those insurance companies. Better give your Dad a big kiss. I'm sure he'd be happy with that until after your surgery when you can give him a big pain-free smile! Best of luck, and I have heard NM is beautiful--my wife's pain doc has a place near Santa Fe where he goes trout fishing. Of course, I wish he'd spend his time here worrying about how to make my wife pain-free so she can enjoy our vacations!
[Edited to remove cuss word. Thanks for your cooperation - Well-come Moderator.]
[This message has been edited by Well-come (edited 05-16-2003).]
Well, until I met my most recent dentist. We will see when the orthoic comes in, that will be the real truth. I can not tell you how much that tens unit relieved my symptoms. The "ghost" tooth pain is gone, the eye pains are gone, the ringing in the ears, facial pain and numbness. I tens for two hours each night on this tens unit designed specifically for TMJ. Now I must admit that by days end I am feeling some symptoms and the more I talk, the more I feel it. But the tens unit allows me to sleep well, enjoy 75% of my day at this point.
[This message has been edited by DianeTMJ (edited 10-30-2003).]
I'm going to go ahead and attack your questions since I don't have much time right now.
I have had TMJ for 8 years or more. It's been bad for the past 2-3 and I've been more actively pursuing treatment. Although, I have always been with some sort of doctor.
I have tried a lot of splints... NTI, repositioning devices, flat splints, soft splints, this splint, that splint. I lost count of how many I've had. Most of them just didn't work, and some of them made my jaw pain worse.
I have tried physical therapy, including ultrasound, radiofrequency, TENS, exercises, ionopheresis. I have had injections of steroids and anesthetics into the joints (that really really hurts- I passed out one time). I've had trigger point injections. I've had occipital nerve blocks, facet joint injections, cervical something or other injections all done by an anesthesiologist.
I've been treated by dentists, oral surgeons, nuerologists, anesthesiologists (pain managment doctors), general practioners, etc.
I've been on a soft diet since '96ish. All of these treatments have given me either disappointing results, made things worse, or kept things the same.
I've tried many medications. In anti-inflammatories I've tried relafen, mobic, naproxen, advil, and more. I had an allergic reaction to vioxx so I cannot take the new fangled drugs like celebrex and bextra. I've been on a lot of muscle relaxants, currently on soma, and I've found that I like it the best. I'm also on skelaxin during the day because it is non drowsy. I've tried flexeril, valium, xanax, zanaflex, and more.
I've had one surgery so far- an arthrocentesis which is basically a flushing of the joint and then injection of steroids. This left me worse off and caused my jaw to lock permanently closed.
Currently I'm seeing a pain specialist in conjunction with my oral surgeon, and taking opiate pain medication. This has helped somewhat and I am glad that I have gotten over the stigma of taking these drugs. I don't know that I could get out of bed without them.
I can't help but think that if I would've taken better care of myself way back when this first started, I wouldn't be in this boat now. But who knows- it could've ended up this way no matter what I did and how hard I tried (I don't know if I could've tried any harder...).
I'd like to thank you for asking these questions because in writing this post, it has made me realize yet again why this surgery is indeed the right decision for me.
It sounds like this TENS machine is doing very well for you. Relief 75 percent of the time is a great thing!!! Why don't you just wear the TENS machine all the time??? hehehe. Anyway since the TENS machine works so well it seems like you can deduce that your problems are in your muscles and not your joints. For that you are lucky because if you get the muscles to relax, you have relief.
Anyway I must go, but feel free to ask as many questions as you think of. I've been through it all!
Hope you're having a pain-free night,
[This message has been edited by goodwillstacy (edited 05-15-2003).]
"love all, trust a few, do wrong to none."
Stacy, your post just blew me away. When I had my first surgery about 12 years ago in Atlanta, they had just passed the law that states insurance companies HAD to cover you for 'minimal care'. But they paid 100% for my arthroscopy....unbelievable that your insurance won't cover it...I would actually, if you know any lawyers, have them look into this. I know the law states that for TMJ they only have to cover so much, but why can't your doctor call it something else? The Myofacial Pain thing seems to get immediate response from most companies....
Just a thought. I am so sorry that they actually said that they think you need the surgery but just don't want to pay for it...how awful. I am very happy that you have such a great Dad though...he needs to get a hug from all of us! I hope that after going through all of this stress, that your surgery goes really great and that this fixes your problem so you can start to enjoy life!
Best wishes and much support and prayers!