Words of encouragement from a 90-year-old broken jaw survivor

26 Jun

Reader Melinda, whose mother broke her jaw last summer, sent me this picture of her parents. I first heard from Melinda last August, when Melinda commented,

My mom broke her jaw in two places last month. She is having the wires removed the day after tomorrow and I don’t think she has any idea that she won’t be having a big bowl of spaghetti upon her return home. I certainly didn’t know. This will give me a chance to prep her for what is to come, so all those disappointment tears you all shed will not go to waste. It will save my mom from being disappointed. She’s 89 and very fit. This has totally exhausted her. Just trying to get 1800 calories in a day has been challenging. She will appreciate knowing she’s not alone. With any luck, she’ll actually start using the Galaxy Tab we got her and she can post, ask questions, etc. with you as you all recover. Best wishes for a speedy and full recovery to you all.

In late September, she gave the following update:

She had the wires removed on Thursday and was immediately in better spirits. And no rubberbands! Her jaw range of motion is remarkable. She was eating, and LOVING real food. Still can’t wait for a salad.
I found that Bertolli has stars pasta, like the tiny stars from chicken and stars soup. Really mini pasta. She also wanted cheese, mozzarella was soft enough. And scrambled eggs. She proves over and over what a strong person she is.
The other thing I noticed was the second the wires came off she was not as scared and timid. She said she was so fearful of falling or choking.

This week, Melinda posted another update:

I do have good news to report. My mom fell last August and broke her jaw in two places. When I tell you how old she is, you’re going to think it was some old lady mishap (I guess it was). She turned 90 last month. She has all her faculties. The good news it, she is fully recovered. In 10 months!
She even had a steak recently. But no more popcorn, ever. 😦
So, hang in there. I know it’s easy for me to say, but if my mom used a computer, she’d tell you the same thing. A good attitude helped. My dad helped (he’s 92). But most of all, getting enough nutrition helped. And enough water.
We made a list of all the things she had to consume everyday. 1800 calories in liquid form is a tough order! And even when she said she never wanted another bowl of soup, she ate it. She says now that all she did for the time she was wired was suck. Morning, noon and night. But she is perfectly healthy. Her only complaints are her lips “don’t feel like before” and her chin is a little tingly.

Melinda also wrote in an email to me today, “My mom would say, ‘If this little old lady can get through it, so can you.'”

If you would like your broken jaw story featured in a post, send me an email.

If you can’t talk at all

22 Nov

Reader Jude sent me the following, which will surely be of use to anybody directed not to talk while wired:

I am new to the “club” and thought you may like to add some info to the Wired Communication link.  While my jaw was wired up and doc recommended no speaking at all, I linked with SprintIP relay for FREE telephone service.  I signed up with the help of a speaking family member and then was provided with a relay service telephone number via internet where I would type in a tele number and the relay operator would call that number for me.  The relay service would read my typed info to the person on the other end of the line and then the relay operator would type what the person was saying back to me – including whether the person sounded caring, loving, or angry.  You are also able to receive calls through the relay service provided you have the internet on and set to receive the call.  I found this service extremely helpful because I lived alone and was now able to make doctor appointments, get information to my employer, speak with loved ones, and handle life despite being speech-disabled.  SprintIP relay also provided 911 service for me if I had needed it – which thankfully, I never did.

On a side-note, all conversations are completely private and when I contacted my boyfriend who had been enjoying a night with friends ala good Canadian beer, the sprint operator even noted when he was “burping” into the phone.  Certainly wasn’t the best conversation when I couldn’t join in with the fun, but I was delighted to have the ability to enjoy the party during my wired-up recovery time.  Actually made me forget my pain and woes for a bit that evening.

Guest posts

14 May

Today I received an email from somebody who recently broke his jaw and wanted to write some guest posts for this blog. I thought it was a great idea, so you’ll probably see some of his posts on the blog in the near future.

If you’ve broken your jaw and have something to share but prefer not to start your own blog, I hope you’ll consider guest blogging here. I’ll review posts before they go up, but only to make sure they’re reasonably on topic and uncontroversial. If that’s not okay with you, you should start your own blog. If you’re interested, send me an email, and we can discuss details of how it will work.

A dubious milestone

25 Apr

As of today, the WordPress.com statistics tell me that this blog has now received more spam comments (6,423) than pageviews (6,324).

An interesting turn of events

21 Apr

Just fifty-four weeks after services were rendered, Blue Cross Blue Shield of Massachusetts (BCBS) has issued payment for my jaw surgery. They paid quite a good sum of money, too. They actually issued a check directly to my father, who is the subscriber for the policy, in the amount of $2976, which is what they determined their liability to be. That’s about $1000 more than I’ve paid to the oral surgeon.

Presumably what happens from here is that my other insurance plan will learn that they’ve overpaid and request that the oral surgeon return some amount of their money. I’ll then have to send the oral surgeon a check for that amount.

It wasn’t so long ago that I wondered whether my time spent on the phone with BCBS would save me any money at all. For a while, they were telling me that SHIP had already paid more than they would have paid. Between that and SHIP’s non-duplication of benefits policy, it seemed like I might have already hit a ceiling for the combined payments of those two insurers.

With this development, though, I’ll save roughly $1200, even if SHIP decides that they shouldn’t have paid anything. Needless to say, I’m pretty happy right now.

Coordination of Benefits and Massachusetts Insurance Regulations

11 Apr

If, like me, you have two or more health insurance policies, the order in which the policies pay is determined through a process called coordination of benefits, which in Massachusetts is governed by regulation 211 CMR 38.00 [pdf].

In my case, it gets a little bit complicated because my two policies are from different states. I haven’t looked at California coordination of benefits regulations, but if they differed significantly from the Massachusetts policy it would be possible to have a situation in which neither plan (or both plans) were obligated by their respective state laws to pay as the primary insurer. For now, though, I’m just going to look at the Massachusetts regulation.

A number of my providers incorrectly billed my UC Berkeley Student Health Insurance Plan (SHIP) first. My oral surgeon’s billing person even tried to tell me that I was wrong when I insisted that my parents’ policy should have been billed as the primary insurance. At a glance, it might seem that she is right (211 CMR 38.05):

(3) The benefits of the plan which covers the person as an employee, member or subscriber (that is, other than as a dependent) are determined before those of the plan which covers the person as a dependent.

I’m not exactly covered by my Blue Cross Blue Shield as a dependent but as a former dependent, since the Massachusetts insurance reform allows young people to keep their parents’ insurance for two years after loss of dependency or until age 26 (whichever is first). Still, I’m definitely the subscriber for my SHIP coverage, so it would be tempting to say that this means that my student plan is primary.

However, turning to the definitions section of the regulation (38.03), we find the following (emphasis mine):

Plan: a form of coverage with which coordination is allowed. The definition of plan in the group contract must state the types of coverage which will be considered in applying the COB provision of that contract.

Plan shall not include:
(a) nongroup coverage except for coverage described in 211 CMR 38.03: Plan(d) through (f) above, or when a nongroup plan chooses to coordinate with other nongroup plans;
(b) Medicare or other governmental benefits except to the extent permitted by law;
(c) student accident coverages, Qualifying Student Health Insurance Programs (“QSHIPs”) or other student health plans when designated as “excess only” or “always secondary plan”;
(d) a plan under Medicaid, or any other plan when, by law, its benefits are secondary to or in excess of those of any private insurance plan or other nongovernmental plan.

In other words, the coordination of benefits regulations don’t apply to student insurance plans, so long as those plans specifically designate that they are secondary to other coverage (as SHIP does). When the regulation refers to “the plan which covers the person as an employee, member or subscriber,” my coverage under SHIP is not included, because SHIP–although it covers me as a subscriber–is not included in the word “plan.”

It’s easy to see where providers would get this wrong. When I filled out paperwork, I had to specify the name of the policyholder, but I never had to indicate whether the policy was a student health plan. From the information they had, was reasonable (but incorrect) to guess that my SHIP plan was primary.

The coordination of benefits regulations don’t just determine which insurance company has to pay first. They also determine how the benefits are calculated. This brings me to the point that I found myself repeating over the phone with BCBS on Friday (38.05):

(1) The primary plan must pay or provide its benefits as if the secondary plan or plans did not exist. A plan that does not include a coordination of benefits provision may not take the benefits of another plan into account when it determines its benefits. There is one exception: a contract holder’s coverage that is designed to supplement a part of a basic package of benefits may provide that the supplementary coverage shall be excess to any other parts of the plan provided by the contract holder.

The one exception doesn’t seem to apply here, so the regulation requires that BCBS pay its benefits as if there are no secondary plans. That might seem to imply that they can’t take into consideration the fact that another plan has paid benefits (even if that plan was billed incorrectly), since a plan that doesn’t exist certainly doesn’t pay benefits.

However, there is something of a loophole here. As quoted above, the regulation doesn’t state that student plans are secondary plans. It says that, for the purpose of coordination of benefits, they should not be considered plans at all. Thus, BCBS could argue that they aren’t prohibited from taking the existence of my SHIP coverage into consideration because SHIP isn’t included when the word “plan” is used in this paragraph. Such an interpretation would seem to be contrary to the spirit of the regulation, but it may well be consistent with the letter of the law. I hadn’t thought of this when I was on the phone with BCBS, so I guess I’m just lucky that she didn’t know the law and considered it irrelevant.

The accident site, a year later

10 Apr

Today I got around to visiting the site of my accident, which I had intended to do last weekend. I didn’t want to commit the time needed for a 35-40 mile bike ride, so most of my journey was by BART, with about 11 miles of biking round trip between the station and the site of the accident.

To the extent that this trip had a purpose, it was to see whether the chewed-up pavement had been repaired, and it was this question that left me in some suspense as I meandered my way through the hills of Oakland to my destination, Skyline Boulevard and Grass Valley Road. This time, I approached the spot riding uphill along Grass Valley Road, opposite the previous times I’d been to the spot. A good distance away, the pavement was smooth and clearly relatively new, but when I got closer to the site I found myself on old pavement again.

As I pedaled up the last hill near the spot where I had fallen, I saw a cyclist approach in the opposite direction.  He bounced up and down a few times as he rounded the turn, thus breaking my suspense but fortunately not his jaw.* Soon enough, I could see directly that the pavement hadn’t changed significantly since I was there in July.

Bad pavement

It’s certainly not good pavement, but it’s not the worst I’ve seen. There’s actually a whole block in particular that I ride over pretty much every day, which is probably all a bit worse. It’s also downhill (at least in one direction), but it isn’t on a turn, and (on account of the whole block being bad), I’ve always taken it very slowly.

I don’t know whether the city of Oakland has decided that they won’t fix this or if they just haven’t gotten to it yet. The city certainly has had its share of financial difficulties, so they may not be able to afford to fix this kind of thing these days. As I understand, because they have been notified of the hazard, they are now liable for subsequent accidents caused by the damaged pavement. Of course, there are also signs warning people to take the turn slowly (without mentioning the road hazard), so that might reduce their liability.

I’ll write about the relevant law some time soon. That’s now two posts about law I’ve promised to write. Yawn.

*Let’s just say I’m practicing for a bad syllepsis competition, in case I should ever find one.

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