Monday, June 28, 2010

Warning: This is a rant.

Do you know what TMJ is?

Let me back up.
Today, I am overwhelmingly insensed with our healthcare insurance company and/or our particular insurance plan. Previously, I was under the impression it was a good plan - I was told by others both in and outside the university that "university insurance is great!". Well, in this case, I am sorry to tell you, THEY WERE WRONG.

I have had TMJ since I was in Junior High. The very short explanation is that the TMJ (temperomandibular Joint) connects the upper and lower jaw. Occasionally (due to MANY different causes) the joint can become inflamed, can move out of track, can be painful, and become almost completely useless. And yes, if you plan on eating (or talking, or yawning, or sneezing, or swallowing, or doing anything else with your mouth aside from humming) so if it is rendered unusable you have a hefty problem on your hands - er - in your mouth.

About six months ago the stomach flu ran through our family. I got it, of course, and among my numerous trips to the loo I noticed my jaw began to get worse and words. Surely, I thought, this was only a temporary effect of all my up-chucking. But months went by and it's only gotten worse. So, because I've finally gotten to the point where I can no longer do normal human things (why did I let it get here? keep reading - everything comes down to money eventually I'm afraid) I made some phone calls this morning to see about getting it looked at.

Who do you go to for TMJ? I haven't a clue. So, I called my new dentist. After all, dentists do mouths, why not jaws too? they referred me to an oral surgeon, but before calling them I gave a call to my insurance company to see who their preferred provider was.

And do you want to know what they told me? The words coming out of that woman's mouth were enough to bring me to tears. Literally. "Under your plan, Blue Cross Blue Shield Nebraska will not cover any visit, procedure, or any other thing having to do with the Temperomandibular Joint (TMJ)." Here I am, sucking my breakfast from a straw and you're sitting in your pretty little office telling me you don't DO TMJ?

Now here's my beef: Insurance companies cover ALL SORTS of practically unnecessary procedures (some are called "elective"), infant circumcision, to name one. They also cover treatment for drug abuse, alcohal abuse, and eating disorders. They cover counseling therapy, and sports medicine, physical therapy, and bariatrics - but not TMJ? That seems absolutely senseless.

I have got to know why. Why on EARTH do they function this way? It's as though they're saying "you know, a lot of people have problems with their Jaws, and assisting them is expensive, so we're just going to tell them all NO. On the other hand, we'll gladly assist people who have spent their lives ruining their bodies with harmful chemicals and substances. We'll gladly give them all the financial assistance they need to finish their lives on hover-rounds with attached oxygen tanks. "

How can a problem this painful not be covered - at all?

I am beyond angry, I am incensed. I put this visit off long enough because we've been (quite frankly) breaking even month-to-month and my deepest fear is that my time as a stay-at-home mom will quickly come to an end with any unexpected expenditure. Well, here's that expense. The consultation alone will run $135 out of pocket. And that's BEFORE any treatment. Potential treatments range from temporary muscle relaxants to arthroscopic surgery. Ugh.

To make matters worse (Hey, I warned you this was a rant) I had to cancel our YMCA membership today. I cried right there at their desk as I signed the cancellation form. Between the medical procedures Levi's had done recently, and the out-of-pocket visits I'll need to make here shortly, the $75 simply isn't there.

I had to remind myself as I drove away that we are blessed not to be in debt. We have to make choices - no matter how difficult - about where we put our money. While the Y was absolutely great, it is definitely an "extra". We've made similarly difficult decisions in the past regarding other "extras" (internet, TV, cell service, appliances, new clothes, eating out, vacationing, you name it) but for some reason this one was the hardest yet.

Writing is therapeutic sometimes. I think this time it only made me more frustrated.


Rae said...

I don't know if you knew about this place, but they seem like they would be most experienced to deal with the problem:

I'm so sorry...... :(

Learning to Parent said...

:( Sometimes it seems that insurance is more trouble than it is worth. You are right, it's super crappy. I hope you can get this all figured out!

Also did you know the Y offers reduced prices for memberships? Not sure if you had looked into that or what the requirements are...

Melissa K. said...

Thanks you two

Brynn, I looked into what they call "personal pricing" back when we initially signed up. Unfortunately, you have to be in some seriously dire circumstances to qualify. Their primary basis is gross income and we make too much. This doesn't come as a big shock to me, we don't qualify for any need-based programs (for which I'm glad, and feel all the more blessed).