Tag Archives: oral surgeon

Bills and such

10 Jun

I’ve been out of town for a bit, and I returned home this morning to find some billing-related materials waiting for me.

The only actual bill came from Bay Imaging Consultants Medical Group. as far as I can tell, this has something to do with the x-rays I received in the hospital. This is apparently separate from the radiology item on my statement from the hospital. The bill lists charges for three items: “ORTHOPANTOGRAM”, “SHOULDER COMPLETE”, “FACIAL BONES, COMPL., MINIMUM”. The total charges were $147, but payments from my insurance brought it down to $53.79. The bill doesn’t say, but I’m pretty sure (based on my memory of some paper which I think I have in a big stack somewhere) that those payments come from my UC Berkeley SHIP plan, rather than my parents’ plan (which is supposed to be my primary insurance). I’ll have to give them a call to see if I can get them to bill the other insurer for the remainder.

I also received an explanation of benefits from the university insurance plan for my services from the oral surgeon. The insurance was billed for $3,720, of which $3,200 was for the surgery and $520 was for anesthesia. The insurance company has covered $1,831.82, and they expect me to pay $1,888.18. Of this amount that I’m responsible for, $146.21 is applied to my deductible, $457.95 is my coinsurance responsibility, and $1,284.02 “exceeds the allowed expense and is the member’s responsibility to pay.” For the record, I don’t really understand what all of these words mean, but maybe some day I’ll find out.

I’m hoping that the oral surgeon’s office will bill the remaining balance to my other insurance. I shouldn’t need to remind them about my second insurance, seeing as they called me for information about it while I was still sleeping off the anesthesia from the surgery.

The last related document I received was an explanation of dental benefits from MetLife, which provides my dental benefits for the SHIP plan. This was for the repairs of the chipped teeth. The statement tells me that the fee for my services is ordinarily $372, but the dentist agreed to accept only $286 as part of his participation in Metlife’s Preferred Dentist Program. Metlife reports having paid $208.80, leaving me to pay $77.20. As I understand it, they are applying $25 to my deductible and then paying 80% of what’s left. I’ll have to ask the dentist if they are also billing my parents’ dental insurance. Either that or I will just wait until I have a bill before I do anything.

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Some pessimism

6 Jun

Several weeks ago, I saved a copy of a review on the treatment of condylar fractures to my hard drive. More specifically, the paper attempts to address the question of whether open treatment (surgery involving an incision) or closed treatment (such as the treatment used in my case) of these injuries is better. I wasn’t looking for an answer to this specific question in the article; my oral surgeon mentioned open treatment only as something that would be used if the closed treatment failed.

It was only today that I actually got around to reading the review. I was glad that I wasn’t reading it to find out whether open or closed treatments are better because the findings were inconclusive. Nonetheless, I did learn some interesting things from it. I was particularly interested in one of the findings of a study of Ellis and Throckmorton:

The patients whose condylar process fractures were treated by closed methods had significantly shorter posterior facial and ramus heights on the side of the injury, and more tilting of the occlusal and bigonial planes toward the fractured side, than patients whose fractures were treated by open methods.

I’m unfamiliar with many of the words in there, but to the extent that I understand the sentence, I think that it might confirm what I have suspected: that the asymmetretry in my mouth’s opening may be related to the way in which my bones have healed, and not just a result of stiffness in the muscles. In particular, the ramus is a part of the mandible, and apparently it is sometimes shorter after a condylar fracture has occured. This isn’t actually something that is of particular concern to me, but I do wish that my oral surgeon had acknowledged it to me.

Other studies found that patients with closed treatment experienced chronic pain and malocclusion (misalignment of the teeth), neither of which I’ve experienced since treatment.

Twenty-three with braces

2 Jun

These days, the only major sign of my accident is the arch bars on my teeth. The oral surgeon told me that they’d stay on until my mouth is opening normally enough that he is sure they won’t be needed again. As the days progress, I find myself increasingly impatient for this to happen. I don’t particularly mind the look, and the arch bars aren’t even that visible. It’s just that I feel like I’m about ten years too old to have braces on my teeth.

Over the last week or so, I’ve been stretching my jaw muscles more and more. The oral surgeon only told me I should work on opening wider, but sometimes I work on the side-to-side motions a bit, hoping that it might help to correct the problem of the right side of my mouth opening further than the left.

The truth is that I don’t even really know how far my mouth should be able to open, or even what straight is. The latter question seems like it should be easily settled, but it’s not so easy because my front teeth aren’t perfectly straight. Some of them have shifted slightly since the accident (owing to my inability to wear a retainer while my jaw was wired), and two were chipped and then repaired artificially. The oral surgeon wants me to focus on keeping my chin straight, but even that’s not so easy because my chin has a small bump on the right side where it was stitched up. As for the width of the opening, I haven’t been able to find out what is normal, but I’m pretty sure that it’s wider than my opening of about four centimeters.

If there’s one thing that keeps me from sitting around and exercising my jaw all day long, it’s the understanding that my trying too hard to fit in may well have caused the accident in the first place. I’m not quite sure what could go wrong here. I doubt that my muscles are strong enough to break the bone again, but I’d rather not find out.

Chewing

20 May

When I went to the oral surgeon’s office today, I was surprised that he didn’t do anything–save asking me how I was feeling–to verify that I was ready to chew again. There was no x-ray and no poking or prodding of the site of the injury. I now have medical clearance to chew everything except for “super-hard” foods. This class of excluded foods includes beef jerky, crisp apples, peanuts, pretzels, hard French bread, and carrots. The oral surgeon assured me that there is still “a ton” of food that I can eat, but my jaw just isn’t ready for the harder foods yet. I assured him that I wasn’t feeling psychologically ready for those foods yet either. Even though my jaw had felt strong for a while, I couldn’t imagine testing it on something hard yet.

The surgeon only looked at my mouth to see how far I could open it without the rubber bands, which I will no longer have to wear. He said that I still had some work to do, and he explained that in the next six weeks, we would be working on getting my mouth to open further and straighter. He instructed me to spend a couple of minutes a day just opening and closing my mouth in the mirror, making sure my chin remains straight. I’ll be returning to the oral surgeon in about three weeks, and he said that he’ll give me some more specific exercises to do if my jaw isn’t back to normal by then.

On my way back to campus from the oral surgeon’s office, I stopped for a falafel sandwich. I’ve tended to eat out very infrequently since starting graduate school, but this seemed like as good a time as any to splurge. The only difficulty in eating the falafel was getting it into my mouth, which required me to squeeze the (rather thick) sandwich a little bit. It was late to be eating lunch, and I was hungry, so I chewed and ate it quickly.

Since the first meal, I’ve been munching on various things. I’ve had a couple of different kinds of cookies, a frozen burrito, and a Trader Joe’s Spicy Spinach Pizza. The (cheeseless) pizza had been in my freezer since the week of the accident, and I found it to be a bit chewier than the ones that haven’t been frozen, so I took care to let it start to dissolve in my mouth before I chewed it. I would have liked to start cooking, but I didn’t have ingredients for anything until after I completed a shopping trip, and by then, it was late, and I was hungry. I’ll make a celebratory meal tomorrow, though.

A healed bone (I hope)

20 May

It’s been six weeks to the day since my surgery. I’m going to see the oral surgeon this afternoon, and if all goes well, he’ll find that my bone has healed and tell me that I can start chewing softer foods again. I don’t know how he’ll determine whether the bone has healed, but my guess is that he’ll take an x-ray.

Regardless of what the surgeon might say later, my jaw feels ready. There’s still a little bit of numbness in the area, and I still can’t open it all the way, but it has acquired a feeling of strength that wasn’t there a couple of weeks ago. Three weeks ago, as I approached the moment of my unwiring, my excitement was gradually replaced by nervousness, but (at least so far) that isn’t happening this time.

A corollary and a question

14 May

This morning, when the person from Blue Cross and Blue Shield of Massachusetts told me that no claims had ever been submitted for me, it occurred to me that this meant that the oral surgeon’s office hadn’t yet submitted a claim. This isn’t a big deal, but if they were going to wait five weeks before submitting the claim, did they really need to call me for insurance information just two hours after the procedure, while I was still sleeping off the anesthesia?

Checking in with the oral surgeon

12 May

Today was my two-week check-in with the oral surgeon, although I’ll actually only have been wireless for two weeks as of tomorrow. I went in to the appointment not expecting much to happen, and the appointment pretty much lived up to expectations. The surgeon asked if I had any problems or questions, and I mentioned to him that I’d need more rubber bands. He looked at my mouth and observed that I had done a good job putting rubber bands in. He asked if I had any more questions, and I mentioned that I had noticed that my mouth seemed to be opening a little bit further on the right side than on the left side. He had me open my mouth and close it a few times, and he told me that it looked pretty straight, but he could see what I was talking about, and that the exercises I’ll start next week will help with that.

The oral surgeon gave me some more rubber bands, “a whole bunch of them”, as he put it. These rubber bands came in a sealed plastic bag, which stood in contrast to the white paper envelopes I had received previously. I’m usually not a fan of plastics, but in this case I appreciated the difference of materials because the small paper envelopes have tended to fall apart in my pocket. The rubber bands inside were different, too. While the old ones were a yellowish color, the new ones were almost transparent. As I left, I hoped that these new rubber bands would be better quality than the ones that had been breaking so frequently over the last two weeks.

I made an appointment to return to the oral surgeon next Wednesday. After that appointment, I will no longer need to wear rubber bands, but the arch bars will remain in my mouth. If all goes well, the arch bars won’t actually be needed, but in case something should go wrong and need rubber bands again, it will be easier if the arch bars haven’t been removed. Also, I expect that after my next appointment, I’ll be able to start chewing soft foods again.

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