Jaw Surgery to Save My Teeth

Hi! I'm Heather.  I'm a very lucky, generally healthy, 34 year old gal who has a very small, underdeveloped upper jaw (AKA maxillary hypoplasia).  I have had issues with my teeth and bite for as long as I can remember. 

In adolescence, I had large gaps between my top 6 front teeth and shortening of the right half of my upper teeth - instead of braces or surgery at that time, I was advised to simply put bonding on the teeth to fill in the gaps.  This bonding made things look a bit more typical.  Although the bonding chipped regularly and required repairs every year or two, it made me feel a little more "normal."  Unfortunately, that treatment just masked the underlying issue contributing to my abnormal tooth wear and ill-fitting bite -- my upper jaw is underdeveloped and asymmetric in a way that causes my front teeth to grind whenever I need my molars (back teeth) to touch to chew food.  This misalignment has caused extra pressure on the top front and right teeth, wearing the enamel, making the teeth thinner from front to back as well as shortening them.  I've started noticing that some of the teeth are feeling a little loose and there's an ache at the root of a few of them when I bite a certain way.  

All of these issues came on gradually.  I didn't really understand what was going on, but when I went to school to become a Physician Assistant, I learned more about the anatomy of the jaws and it started to make sense.  It took me some time and asking the right questions to my dentists to figure out the underlying cause and best treatment option.  In 2012, at the end of PA school, based on the recommendation of 3 dental, orthodontic, and orthognathic surgeon teams, it was clear that a surgery called a Le Fort I procedure would be the best way to realign my upper jaw so that it's more congruent with the lower one. 

I went to the recommended visits, got braces (the first step for this surgery), a prior authorization was approved through my insurance, and I was scheduled to do the procedure in the fall of 2012.  During that summer, I started my new "big girl job" as a Physician Assistant at Gillette Children's in St. Paul.  I was ecstatic!  The job in pediatric orthopedics was a dream.  Not only did I get to help patients of all ages manage bone and joint issues, I was going to get paid to do it!  I had a solid salary and new benefits - like most full time employees, I would have a health insurance policy subsidized by my employer which meant my premium would go down significantly compared to the plan I had paid for myself.  In July 2012, I switched from the United Health Care policy I had purchased during PA School to the HealthPartners plan through Gillette.  I didn't even consider that this would impact my tooth saving strategy - this fancy new policy through work seemed like it would be a step up from the poor student one I had before.  Unfortunately, I quickly learned that my policy had a lot of fine print regarding orthognathic (jaw) surgery, and my new policy would not cover the planned procedure unless I could show evidence of such significant jaw deformity that I was suffering from Failure to Thrive (a nice way of saying starvation) and/or suffering from such significant sleep apnea (inability to breathe during sleep) that even a C-PAP machine couldn't relieve my symptoms.   My surgeons reassured me that oftentimes insurance policies will refuse a prior-authorization initially, but then change the decision after an appeal is made.  They sent additional documentation to HealthPartners and we were refused again.  I was told I could appeal directly to my employer, since all spending of our plan is ultimately managed by an administrator in our own organization -- I wrote a personal letter to the leadership teams and was again told that the cost of my surgery would not be covered. 

I gave up.  I was sad that I couldn't get the care I needed, but life would go on - besides I had a new job to do and so much to learn.  I kept the braces on for a total of 18 months - they could at least close the gaps between my front teeth and try to adjust things a little.   I avoided sandwiches and other food that was tough to chew and went about my life.  Then, a few years later, I was waking up at night and in the morning with a sore jaw.  I slept with my retainers and they were getting worn down.  I started noticing a feeling of a "step off" on the back of my front teeth.  My new dentist in the twin cities confirmed that my bite wasn't ideal, they asked if I'd consider surgery.  I told them my story and we opted for an extra bite guard at night.  This helped some but my gums became sore from the guard.  The following year, more of the bonding on my front teeth popped off.  I had it repaired.  They suggested veneers as a more permanent solution, they'd fill the gaps and protect the tooth surfaces a bit.  Since my bite was off, I'd need to get full caps on a few of the teeth, or just prepare for the veneers to pop off sometimes.  Friends who have been through this process suggested doing caps - they said they dealt with actual nightmares after having veneers pop off a few times.  I tried to get a prior-authorization done one more time, but felt guilty and discouraged when it was denied.   Over the years, I felt alternately angry at the industry for denying what was being recommended and ashamed at myself for wanting so badly to get the procedure done.  If the insurance company didn't think I needed it, maybe I didn't really need it?  Was I just being superficial?  Do I even need teeth? 

But last spring, after thinking and stressing about my teeth in some way every 6 months or so for the entire 7 years of my adult career, I decided it was time to save up and just do this procedure, even if insurance wouldn't cover it.  By this time, I had a team of dental professionals that I really trusted.  My dentist and new orthodontist, although they work on opposite sides of the metro, took time to meet as a team and talk through my options and decision.  I found a surgeon that everyone trusted.  We tried to get the procedure prior-authorized, and it was denied again, even after multiple appeals.  I decided I'd save up and just do it anyway.  I got braces on last year, July 2019, and have had multiple adjustments and appointments to prep for the surgery.  Surgery was scheduled in Chanhassen for April, but because of COVID, I've rescheduled.  In the meantime, the surgeon that I planned to work with has stopped operating (he's done more of these than anyone in the metro - he did my coworker's sister's Le Fort in the 80s...).  

I was discouraged to have to find a new surgeon.  Since I work in surgery, I know "enough to be dangerous" - meaning I understand that not all surgeons have the same skillset and experience REALLY matters - it can change the amount of time an operation takes by HOURS as well as decrease the risk of bleeding and complications.  I wasn't really interested in having this done by someone who has done it a handful of times... Feeling unsure about next steps, I went on with things.  I volunteer with a group of people from around the US who travel to Guatemala to do orthopedic surgery every March.  This year, we met there before COVID restrictions were in place.  Unfortunately, due to the virus, our team chose to cancel the surgeries to avoid putting any locals at risk of infection.  We worked together to organize our supplies and most of our team went home early.  I had a few extra days with a few teammates from North Carolina.  Over breakfast one day, I complained about pain in my jaw and explained the surgery I'm hoping to have.  My friends happen to work in the Charlotte area with a group of physicians who specialize in jaw realignment!  They gave me the name of a few of the more senior surgeons and said they have watched them do the Le Fort surgery tons of times - they do this procedure every week, sometimes up to 3 times per day!  They even do the surgery in an outpatient surgical center, meaning I wouldn't need to stay several nights in the hospital, as had been planned for my case in Minnesota.  Doing the surgery as an outpatient procedure could save me thousands and would decrease my risk of COVID infection.  More than anything, I was ecstatic to hear about the number of times they've done this - as I mentioned, I have seen enough surgeons work to know that repetition and experience MATTER.  

So, very long story short - I'm scheduled to have the Le Fort surgery done in an outpatient surgical center outside of Charlotte, North Carolina on October 15, 2020.   The total cost after the "discount" for not using insurance is $28000.  With the changes to my hours and salary with COVID, I haven't been able to save as much as I'd hoped.  I have saved up around $13k that I can put towards the surgery.

I will get this done and will take out loans if needed, but I'd love to come out of it with as little debt as possible.  I'm asking for financial help to finally have this surgery and move on.  I promise to stop talking about my teeth and smile more than ever when it's all done. 

Any donation that you can give would be so appreciated. 


Love,

Heather