I took some more pictures today.

My Bengal cat showing some affection.

So, it’s been finally 5 months since surgery.  To tell you the truth, I never thought I would get here because it felt so dang far away!

Things I’m doing now?  Well, I’m eating almost everything.  I still haven’t been able to tackle things like Bruschetta or Kettle chips.  I’m slowly getting there.  I continue to have issues with my chin and lower lip.  As the cold weather approaches, I find it more difficult to articulate my words without some nerve pain.  I’m learning to ignore it in fun situations but if I’m not doing anything, then I will definitely feel the “frost bite” sensation.  I’ve got 7 months till I reach the 1 year mark, so I think I have plenty of time to continue recover my nerves.

Things I’m looking forward to?  I’m slowly getting my smile back.  I think it still looks a little off but the doctor said at 6 months the smile usually returns to normal.  My face continues to change and I do look forward to the day that stops.   I also cannot wait to get my braces off.  My orthodontist tells me that I have about 4 months left.   Yippee!  I’m hope that happens!

Socially.  More and more people are telling me that I look different.  Even people who saw me after surgery say I look different than 3 months post op.  Some old friends don’t recognize me and a lot of the time I’m not sure what to make of it  I constantly second guess myself but I’m trying to love the new face that stares back at me.  There are a lot of unexpected things to deal with when getting a new face shape.

Pictures.

Here are my 5 month post op pictures.

My daughter just finished celebrating her 7th birthday.   My precious little angel is getting so big.

It’s the beginning of her 1st school year at a new school and I was quite eager to meet some of her new friends.  As all the families rolled into the party room, I talked with them all.  Everyone.  I think we must have had 43 people at the pool party.  We had a great time.  I’m sad I didn’t get much time with my daughter but I guess it goes with the territory of hosting a party.

I woke up this morning, more tired than usual.  Going to bed 2 hours earlier than usual didn’t seem to rejuvenate my energy.  Today, I am still exhausted and my mouth is sore.  Maybe it was the talking?  I must have chewed on my lip at least 4 times today.  So, I got to thinking.  When does it stop?  The extra swelling and soreness after using your mouth “too much”.

For the past few weeks I’ve been working to get a refund check from my talented surgeon.

Blue Cross Anthem ended up paying for my genioplasty after all.  Prior to surgery, my insurance authorized the surgery for both upper and lower, but stated the genioplasty would be considered cosmetic.  I didn’t bother fighting it.  To be honest, I was in a hurry to get this process over and done with it.  The anxiety alone in waiting a few more weeks or even months to appeal the decision was something I just did not want to go through.  So, I prepared to pay the rest out of pocket with the hopes that the anesthesiology bill for the genioplasty wouldn’t be billed to me but wrapped up under the jaw surgery time.

After surgery, I got my Explanation of Benefits and saw that Blue Cross ended up paying my surgeon for the genioplasty.  I was surprised he was only paid somewhere around $300 when I paid close to $2500 up front for the work.  An amazing difference in price, wouldn’t you say?  During my next doctor’s visit, the office manager mentioned to me that they were surprised to get the money for it and were going to double-check with the insurance that the claim was meant to be processed that way.  I guess they wanted to make sure that the claim wouldn’t get audited and then I get the same bill a year later.

I went home and did some research.  I felt fairly confident that Blue Cross paid this bill correctly after I found their jaw surgery medical policy.  It states under “Cosmetic and Not Medically Necessary”:

A genioplasty (or anterior mandibular osteotomy) is considered cosmetic and not medically necessary when not associated with masticatory malocclusion.

When I read this, I thought OK, what qualifies as a masticatory malocclusion?  If I have it, then I must be covered.  I found this in the medical policy:

Masticatory dysfunction or malocclusion as documented by both I and II below:

1. Completion of skeletal growth with long bone x-ray or serial cephalometrics showing no change in facial bone relationships over the last three to six month period (Class II malocclusions and individuals age 18 and over do not require this documentation); and
2. Documentation of malocclusion with either intra-oral casts (if applicable) bilateral, lateral x-rays, cephalometric radiograph with measurements, panoramic radiograph or tomograms.

So there it was.  What I needed just in case I was denied for the genioplasty.  Since I fit their definition of having a Masticatory malocclusion, then the genioplasty must be covered.  Hooray!  I figured it out!

Fast forward to yesterday.

I FINALLY heard back from Blue Cross on Friday.  They confirmed that the claim was paid correctly.  It was a matter of seconds before I called my doctor’s office to make sure they heard from the insurance company.  The office manager must have recognized my phone number and immediately told me the check was being written that day.  She also shared with me on the back of the Blue Cross letter it was written in big letters to REFUND PATIENT!  Haha.  That’s right!!

So, next week, I will be about $2500 richer.  I’m so happy to be getting this money back.

ALSO.  I don’t know if I mentioned this before but I got a 30% discount on my hospital bill.  See, there’s a little secret.  Most hospitals want to finalize hospital bills immediately.  So, they will be quite flexible if you ask if they have any payment plans and that is exactly what I did.  I had 2 options.  Pay over 8 months, interest free OR pay it all that day at a 30% discount.  So, in a 2 minute call, I shaved over $500 off my bill.

Here are my revised costs:

Surgeon Fees

• $12,310 Billed
• $3066.05 Allowable    
• $531.61 My Responsibility

Anesthesiologist Fees

• $3600 Billed
• $2,628.21 Allowable    
• $262.82 My Responsibility

Hospital Fees

• $95,521 Billed     (This number seems awfully high, RIGHT??  I was there for 1 night!)
• $1,953.54 $1367.48 My Responsibility (30% discount – I talked about how I did this in the post written above)
  

Deductible

• $250

And….

Surgeon – Genioplasty Fees (not approved by insurance)

• $2473 Billed
• $2473 $0. My Responsibility
  

Total Responsibility:  $5470.97 $2411.91

4.5 months post op.

I feel a bit lucky.

No cavities so far.

I was very worried about getting a cavity after jaw surgery.  The environment seemed perfect.

Stuck Food.  Less Brushing.   Flossing – HA!  Like that was going to happen!

Right out of jaw surgery, I was good.  I was banded but I brushed the outer side of my teeth after each and every meal.  Like the dentist tells us to do but most of us don’t when we’re “normal”.  I was insanely worried that I would get food in my stitches or worse.  Get a cavity that needed to be taken care of immediately with a jaw that wouldn’t open.  A situation I wanted to avoid at any cost.

So, what measures can be taken to avoid nasty plaque buildup?  Here are the steps I took.

1. Rinse your mouth out with water.  Hopefully you have a 2nd syringe to use for brushing.  Slowly squirt the water near the backside of your mouth.  Repeat until the water runs clear out of your mouth.
2. Use a child’s size toothbrush.  The small size will be able to fit into your mouth and you can brush your front teeth, at the very minimum.  Brush your teeth and gums with a gentle massage.  Since most of you can’t feel your gums post surgery, you don’t want to be sawing them away.  For toothpaste, I recommend using Original Protection Crest.
3. Don’t rinse your teeth, just yet.  You want to leave the residue there for the next part. You can spit out any globs of toothpaste (just DON’T RINSE).
4. Using a syringe, fill it with either your prescribed mouthwash or Listerine (mix 1:1 ratio with water), and rinse out your mouth.  I paid special attention to the areas I was cut and where I had been squirting food into my mouth.
5. If you feel especially brave, you can incorporate “flossing” with soft brush picks (found here).   I used them when I started to introduce soft foods into my diet.  If you are eating meats, like ground turkey, I would definitely recommend adding this to your brushing schedule.  I always found little bits of it trapped everywhere in my braces.

Gum Recession

I started getting gum recession after I had my first child.  The doctor thinks it was because I was on my 2nd round of braces and pregnant (pregnancy hormones can alter oral health).  What also contributed to it? I had an illusionary good bite.  But if you looked up close, I had an overbite with an overjet.  My teeth were straight but VERY tightly sitting next to each other.  I could feel the pressure placed on some teeth and guess what, those were the teeth with the worst recession.  And that’s where the idea of jaw surgery became more real.  I had to remove teeth to resolve the overjet, but in doing so, I would create a worse overbite.  Which would mean, I required…jaw surgery.  (You can read my story here).

If you are starting to experience gum recession, this informative brushing site is a great resource:  Dr. Ellie DDS.   Because of braces and jaw surgery, we are more prone to gum recession.  We got to protect our investment!

xo