Wednesday, October 29, 2008
Appointment Scheduled
I am scheduled to see the maxillofacial specialist the weekend of Shrimp Festival. Hopefully I will have something positive to report!
The next days, weeks, months!
The Sunday following my trip to Dr. Rubio, I thought it best to return to the states and get assistance from insurance to pay for the reconstruction. In order to start the process with AHCCCS in Arizona, I needed to visit an emergency room, which I did. The evaluation was completed and I was referred to complete the application process with the Department of Economic Security (DES), which I did, and was subsequently denied.
REASON: Failure to provide last date of employment.
MY REPONSE: The college I worked for stated that I could not request this information, that it needed to be obtained by DES. The caseworker told me to reapply and that my ER bills would be covered with the new application. UNTRUE
ACTION: Re-appliedFiled a new application in February 2008 and was denied again.
REASON: Failure to provide proof of self-employment income.
MY RESPONSE: UNTRUE. Fax submitted 2/26/2008 with date stamp proved that the statement was received. There was additional information included in the fax, on the SAME LETTER, that was accounted for.
ACTION: Appealed denialGranted appeal, I thought this would be a victory. Simply not the case.
Saw general physician on May 27, 2008 and was referred to oral surgeon (maxillofacial specialist) Drs. Sabol and Buhrow. Saw Dr. Buhrow on July 15. It took that long to get the approval from Care 1st Arizona, my assigned HMO.Doctor wanted to perform a procedure to get movement back into the area where the joint used to be. He said it would make it so the joint would move more freely and give me better range of motion. I did not understand the point of cleaning out the place where a joint no longer exists, but figured he is the professional and knows what he's asking for.Two months later, I was informed that the procedure was denied and got a letter to the fact as well, stating that AHCCCS does not cover TMJ treatment.
TREATMENT???? I HAVE no TMJ joint to TREAT!I appealed the decision and was denied again in September, stating that the procedure is "not medically necessary".So here I sit today, a year after breaking my jaw STILL with the broken jaw.I also have a series of dental work that needs to be done but cannot be completed until I can open my mouth (clearly). I have a scar that has healed surprisingly well, which is the LEAST of my concern at this point.I just need help to raise enough money to have my jaw fixed and post-treatment in Mexico. I will be returning to the Mexican maxillofacial specialist, Dr. Rubio, for this treatment.
Estimated cost of surgery: TBD by consultation (a year ago, the procedure would have cost appx. $4,000 including hospital stay)
Emergency medical services UNPAID by insurance: nearly $5,000
REASON: Failure to provide last date of employment.
MY REPONSE: The college I worked for stated that I could not request this information, that it needed to be obtained by DES. The caseworker told me to reapply and that my ER bills would be covered with the new application. UNTRUE
ACTION: Re-appliedFiled a new application in February 2008 and was denied again.
REASON: Failure to provide proof of self-employment income.
MY RESPONSE: UNTRUE. Fax submitted 2/26/2008 with date stamp proved that the statement was received. There was additional information included in the fax, on the SAME LETTER, that was accounted for.
ACTION: Appealed denialGranted appeal, I thought this would be a victory. Simply not the case.
Saw general physician on May 27, 2008 and was referred to oral surgeon (maxillofacial specialist) Drs. Sabol and Buhrow. Saw Dr. Buhrow on July 15. It took that long to get the approval from Care 1st Arizona, my assigned HMO.Doctor wanted to perform a procedure to get movement back into the area where the joint used to be. He said it would make it so the joint would move more freely and give me better range of motion. I did not understand the point of cleaning out the place where a joint no longer exists, but figured he is the professional and knows what he's asking for.Two months later, I was informed that the procedure was denied and got a letter to the fact as well, stating that AHCCCS does not cover TMJ treatment.
TREATMENT???? I HAVE no TMJ joint to TREAT!I appealed the decision and was denied again in September, stating that the procedure is "not medically necessary".So here I sit today, a year after breaking my jaw STILL with the broken jaw.I also have a series of dental work that needs to be done but cannot be completed until I can open my mouth (clearly). I have a scar that has healed surprisingly well, which is the LEAST of my concern at this point.I just need help to raise enough money to have my jaw fixed and post-treatment in Mexico. I will be returning to the Mexican maxillofacial specialist, Dr. Rubio, for this treatment.
Estimated cost of surgery: TBD by consultation (a year ago, the procedure would have cost appx. $4,000 including hospital stay)
Emergency medical services UNPAID by insurance: nearly $5,000
What Happened?
I broke my jaw in an ATV accident on October 12, 2007 while visiting San Felipe with my son. I was seen at Hospital San Felipe next to the Police Station, and they treated me famously. The doctor spent about two hours piecing my chin back together. Little did they know that my entire TMJ on the right side was smashed. I also had a tooth on top that had mushroomed into my jawbone.
I visited an oral surgeon in Mexicali five days after the accident to have the tooth extracted and for an evaluation on the damage to my jaw. Dr. Rubio was exceptional, provided me with caring treatment and a thorough evaluation of the jaw. He stated that the jaw was broken and needed to be repaired.
I visited an oral surgeon in Mexicali five days after the accident to have the tooth extracted and for an evaluation on the damage to my jaw. Dr. Rubio was exceptional, provided me with caring treatment and a thorough evaluation of the jaw. He stated that the jaw was broken and needed to be repaired.
Donation Received!
Thanks to one of the local ladies for her $500 check. That will be going into an interest-earning account so the PayPal fees won't be assessed. That brings the balance up to $813!
Thursday, October 9, 2008
Tuesday, October 7, 2008
Donation Received
Thank You! Account Balance: $290.10
As you all know, PayPal takes a percentage of your donation: 2.9% + $0.30 per transaction. That's why the total amounts look so strange.
As you all know, PayPal takes a percentage of your donation: 2.9% + $0.30 per transaction. That's why the total amounts look so strange.
Monday, October 6, 2008
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