Co-pays, Medications, & Premiums, Oh My!

August 2005

(you can click on any photo to get a larger image)

I just have to vent some today. It is hard not to think that insurance companies are just a little bit evil. So far I haven't had many run ins with them and things have gone fairly smoothly. I have been frustrated with the costs going up like everyone else but have just been going along. However, now I feel actual anger towards them. Not just one company though. After YEARS (at least 20 years?) of paying our insurance companies, co-pays, etc. now we need to really take advantage of having insurance. I am hoping after a little venting I will feel better.

My youngest daughter, Hannah has been in braces for almost 4 years. (She did have a break for a few months.) Our orthodontist said that he would do all he could do but that she was probably going to need surgery. He recommended a couple of oral surgeons. We talked to one and Hannah thought he was the greatest. He really was great too. He is kind, funny, and very intelligent. The goal was to have oral surgery this summer.

(This was the first day that they put on braces.)

We had an appointment with the oral surgeon over a year ago. He sent a letter to our insurance company. They would not commit totally but said that they usually cover this surgery 80%. Considering the total is about $6000 we were very pleased with this.

(2005-I have some pictures that I took when she first started in braces so we could see her progress. )

The surgery that Hannah needs is called Orthognathic surgery. This is when the lower jaw doesn't grow out to meet the upper jaw. You can find out more information about it here.

A portion of the page is below.

The result can be a host of problems that can affect chewing function, speech, long-term oral health and appearance. Injury to the jaw and birth defects can also affect jaw alignment. Orthodontics alone can correct bite problems when only the teeth are involved. Orthognathic surgery may be required for the jaws when repositioning in necessary.

Difficulty in the following areas should be evaluated:

• difficulty in chewing, biting or swallowing
• speech problems
• chronic jaw or TMJ pain
• open bite
• protruding jaw
• breathing problems
  

(Profile that shows how the surgery would change the jaw line.)

In addition to all these things the likelihood of dentures (maybe by age 50?) is increased dramatically. Since the bite is off the wear on the teeth is affected. The surgery will affect her appearance somewhat but the purpose of t he surgery is NOT cosmetic.

If you scroll down on this page the last group of photos shows the situation for Hannah. Of course, her situation is not as bad as the woman in the photo but it gives you the idea of the difference it can make.

Back to the story.....

Now we fast forward to a couple of months ago. The oral surgeon's office calls me and tells me that our insurance company in only paying 60% now. After you add in our deductible and other misc. fees our total cost would be more like $4000.0. Whoa! Not good! I was really upset and wondering what we were going to do. My daughter needs the surgery! The woman I talk to says she will contact the insurance company again but it isn't sounding good at all.


I called her to see what the update was (if any). While waiting for her to return my call my husband calls me to say that his company is changing insurance companies. Wow! I got excited thinking maybe this is the answer to prayer. Maybe the new company will cover it.

My hopes were dashed when the oral surgeons office said, "what is the name of the company? They won't pay at all!". Hmm, the day was not getting any better. I was so angry. If we had done the surgery a year ago it would have been paid 80%. However, she was not in a positioin to have the surgery so that is a pointless thought. Amazing the difference a year made.

Well, that is the update on what is going on here. If anyone has any thoughts on things we can do, besides standing on a street corner with a sign (I haven't totally ruled that one out yet) please leave a comment or email me. Frustrating doesn't even begin to express our feelings on this matter.

You know I ran the numbers. If you add up the insurance money spent (not counting copays & meds) on my 2 girls for ONLY the last 2 years we have paid enough to cover most of this surgery. That is just the last 2 years. That doesn't count the other 18 + for me and my hubby too. That also doesn't take into account that at least 80% of that money was pure profit for the insurance company. We go to the doctor so often that they have to get our records out of storage. We go for years without needing a doctor.

NOW I am done venting. I will get over my anger. :-)
Please, pray that God will provide the money in some way. Also, prayers for Hannah are much appreciated. Surgery like this for a 14 year old girl is scary. It is also scary for her Mom. :-) We are going to be praying for a speedy recovery with no complications. It took me a while to get over the idea of her having this surgery. I finally came to peace with it and now this. Ugh!

(more recent picture-the braces really did their job!)

God is still on the throne. I know that HE knew about this long before I did. I tell you all of this so later on , when HE provides the way, we can give HIM all the glory! Thank you for your prayers.