Thursday, March 19, 2009

Not Covered

Today we have officially started Sophie's Orthodontics. This was something we knew we would be dealing with the day she was born. And earlier this year our Cranial Facial Doctor told us that Sophie had finally lost enough teeth and was at an age to move ahead with the next surgery. But before the surgery could be performed she would need the orthodontics to move her teeth to make room for the bone graft that would be put in her gums. I know it sounds horrible and I cringe to think about what this means for my little girl. The idea of her having to go through this surgery and especially the bone grafting just makes me.... I don't know a bit scared for her and worried about the pain that it will cause.

We saw the orthodontist who is experienced with cleft pallet corrections for a consult a few months ago. Sophie had some very extensive x-rays taken of her teeth, jaws and whole head about a month ago. But today the real work began. Sophie had to go in and get spacers put in to prepare her teeth for the "appliance" as the Orthodontist called it. She also made molds of her teeth so they can make the extender to fit her mouth. We get to go in again next week for more spacers and such and then finally in two weeks she will have the extender put in place.

What is killing me is that this orthodontics procedure is necessary before her surgery (which is fully covered by our Health coverage) but health insurance doesn't cover the orthodontics. And dental doesn't cover the orthodontics either because it isn't really braces, it is a special procedure. So we end up picking up the entire bill for this one. And we have already been told this is only phase 1 of 3. It was somewhat breath taking to see what the estimate was for only this phase. I signed that contract and gave them the down payment but it is daunting to think how expensive this is going to be. I should be more grateful for the Health coverage we have which so far has completely covered all her surgeries (four so far) and doctor visits (which have been too many to count). We are really blessed to have the plan that we do. Thank goodness my husband has a stable job that provides this coverage with little out of our pocket.

It has never even been a question that we would do these orthodontics for Sophie. We were warned the first time we even saw the plastic surgeon, when Soph was only 1 month old, that the orthodontics wouldn't be covered. It is something we have always known was in the future. It has just always been something "in the future" and now we find it on us now. She will have a beautiful smile at the end of these years of extenders, braces and a few surgeries. That will be worth every penny!

For now she is already complaining about the pain the spacers are causing but is being so good about everything. The orthodontist's assistant said she was very cooperative and nice today.

Sophie is a trooper.


Karen said...

Oh! Poor Sophie! I know the pain of spacers (if they are the same ones I had for braces). I have to say that the spacers were MUCH worse than actually getting my braces tightened every few weeks. I just cried for 3 days when I got spacers.

Maybe sure you give her lots of pudding with whipped cream.

Sonja said...

She is so beautiful! And what a trooper. I can't believe the insurance company won't pay for the orthodontics when it is necessary for the surgery which they will pay for. Mind boggling.

Good luck with everything! Hang in there Sophie!

Bibliophile said...

I agree with Karen: the spacers are more hurtful than the actual braces. I extended my time for braces by not doing what I was told to do. Then, you needed elastics to move the teeth slowly, and the pain was bad enough for me to take them off all the time. When I did keep the bands on, it lasted a day or so. I would tell Sophie to keep the bands on and endure the pain rather than take a longer time for the orthodontics. I like the picture of Sophie with Minton!

Anonymous said...

Her light just shines through in all the photos of her. I'm really sorry that the ortho isn't covered.

Malissa said...

Good luck with the process! A little pain in the pocket book, but lots more smiles to come:)

Michal said...

can you appeal? that seems like such a racket that insurance can deny the prerequisites for surgery.

kimball has strabismus, a medical condition of the eyes. our insurance covers his doctor's appointments, but not his glasses, which he has worn since he was 10 months old. it is maddening that they can cover one and not the other, when both are necessary for this condition. and let's not even start on the fact that insurance covers nothing for autism.

but, like you said, having good coverage is a blessing. since my husband is self-employed we have to pay big money just to get a high deductible plan and then pay big money for our care! nevertheless, socialized "free" medicine is frightening to me, having lived in countries where the medical care is provided by the government. i'd rather pay for it and know that we are getting the care we need, even if it requires sacrifice.

tell sophie i'm proud of how brave she is being. i'm sure that some of these steps will be painful, but she is obviously a strong girl.

My Ice Cream Diary said...

I'm sure it hurts to have to pay out of pocket but it is so worth it. I had to have braces or surgery for ingrown teeth and to this day I'm so grateful for what my parents did for me (out of their pockets as well). I went from having a very gapoped bucktooth smile, that grew worse every month, to having a nice straight smile, and I love it.

Hang in their Sophie, you are a tough girl and such a trooper!

Angela said...

This just makes me mad- There are so many hoops and hurdles. Hopefully, you can work something out with your company. I just don't understand the system. Sorry!