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The Twisted Logic of Medical Insurance Companies: My Personal Battle

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Message David Smith
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I have stayed in the wings during the health care debate for the most part, because we are still missing the entire point of reform. There is enough money, and there are enough resources in this country to provide everyone with the health care that they need, as has been demonstrated by numerous other countries, and yet we refuse to consider that health care is a human right, a civil right.

I had the good fortune to be born with numerous orthopedic deformities, and have written an article before on the crazy costs of my recent back surgery. I also have a facial deformation which results from the maxilla bone (upper jaw) being too small, and my teeth are set way back in my head, causing me to dislocate my jaw every time I open and close my mouth so that my teeth will line up correctly. I wore braces 3 times, financed by my parents and myself, but that did not work. I had an employer-sponsored insurance plan once upon a time that actually covered surgical treatment for this condition, which was causing me severe migraine headaches, so I took advantage of it and had the surgery in 1999. They basically rearrange the bones in your face to make the teeth line up correctly. It is no fun, let me tell you. But, even though the surgery was covered, the braces were not - even though the actual braces are used as a part of the surgical instrumentation that is used during the surgery process itself. What twisted person created this rule? I'd like to know so that I can spit on him/her. I paid the $5,000.00 for my third set of braces just so I could get on with the surgery.

The bone fusion failed. My upper jaw is now receding back into my skull, taking my teeth with it, and ten years later, I am now back at square one, with a dislocating jaw joint and migraine headaches. It has been recommended that I undergo the procedure again.

The braces are not covered, which is the first problem - I don't have the $7,000.00 that they want for braces of this nature. Even if I did, I am sure that the vast majority of medical insurance policies have wording that does not cover "TMJ" related surgical treatment, although I have not had the opportunity to review my current policy which is an employer sponsored COBRA plan that is new to me.

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DaveyS is a 5th-generation Texan now living in California, a proud liberal (product of the public education system in North Texas!), and a staunch critic of conservative policies that are destroying our nation.

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