One Small Victory

I received a phone call yesterday informing me that my periodontal treatment has been approved!!! I almost fell off my chair. I have an appointment to receive treatment on Wednesday; my mouth is expressing its approval by aching.

For anyone who doesn’t know, getting this approval from my dental insurance has been quite the battle:

  1. I was in unbearable pain in August, but couldn’t even get an appointment to see my dentist until late September
    1. She sent me to get a root canal for the tooth adjacent to the one that was bothering me (“Endangered Molar”)
  2. I saw an endodontist in late October
    1. He couldn’t do anything for me due to swelling in the gum above Endangered Molar
  3. I had to go back to the dentist, who submitted a referral for me to see a periodontist
  4. Unknown to me, the referral was approved in early December
    1. I didn’t find out about it until I called my insurance about something else in January
  5. I had my periodontal consultation on January 22nd
    1. They sent the request for treatment authorization on January 26th
  6. I had to call my dental insurance multiple times, finally talking directly to a supervisor, before they even acknowledged that they had received a request for periodontal treatment.
  7. They denied the request. Immediately. I didn’t receive the call until Wednesday March 18th, but the rejection letter was dated March 13th – the first possible day they could have reviewed it, assuming they’d only just realized they had it in the first place.
  8. I appealed the decision immediately and sent the periodontist’s office all the information I had from exams at other facilities (to help them build their case). I was planning to follow up with my own written appeal.
  9. They actually approved the request just over a week after I appealed; the letter I received was dated March 27th.
    1. I’m grateful that the periodontist’s office called me as soon as they received their letter and that they held the first possible appointment for me.

I’m a bit annoyed that my appointment conflicts with my group music therapy class – the one where I feel like a valued member of a mutually-supportive group. I mean I could ostensibly go to class a couple hours after receiving surgery in a quarter of my mouth… but something tells me I’m going to need some time to recuperate. I might miss my Thursday class, too. But the periodontist is only available on Wednesdays this month; there’s no way I’m waiting any longer than I have to.

At least it’s happening now, and not closer to the end of the semester when everything will be due.

I’m relieved that I don’t have to write an appeal, or take my dental insurance to court, or call them again …. hopefully not ever. It’s a huge weight off my shoulders!

Let It Go

One thing I’m really bad at is letting things go when they make me angry. I become kind of obsessed with them; I keep ruminating on the situation, what should have happened, why I’m right and the other person is wrong, etc. Occasionally I allow it to ruin my whole day.

Sometimes it’s a situation where Wakana would express concern if I weren’t getting angry – a situation that needs to be resolved. The anger gives me the energy and motivation to take action on it. I need to be assertive in making sure my needs are met – firm enough that the other person knows “I mean business,” but not verbally abusing them or otherwise ignoring their rights and needs. Sometimes I have difficulty finding the balance.

A prime example is trying to get treatment for my Endangered Molar, which has an infection that is causing “extensive” bone loss. (In other words, something is eating part of my skull.) My dental insurance took forever to approve a consultation with a periodontist, and then neglected to inform me of their decision. I had to call them – to learn it had been approved a month earlier!

I went for the consultation on January 22nd; the authorization for treatment was submitted on January 26th. The weeks went by… nothing.

I called multiple times and was told a variety of things, from “we never received that” to “it’s been escalated to a supervisor.” Last week I was told that no authorization for treatment had been received, but I had been approved to see the periodontist for a consultation. It had been escalated and approved just the day before.

I was furious! I told the person I was talking to that I had already been to the periodontist for a consultation and they should have an authorization for treatment. She insisted that what had been received was a referral for a consultation; the authorization was a different thing, the periodontist had to submit a “narrative,” etc. We kept saying the same things to each other over and over, with more and more frustration in our voices. I caught myself starting to slip into some inappropriate language; I knew that if the conversation continued it would likely result in me saying some very mean things. I made every effort to end the call as soon as possible without “hanging up on” the person.

I was fuming for the rest of the day. I couldn’t focus on anything else. I couldn’t enjoy being intimate with my husband. I just wanted to break things – including the skulls of the people responsible! It didn’t help that I was in a lot of pain from having Root Canal Molar extracted. I was miserable.

I thought I had to wait for the periodontist to come back from vacation to submit the “narrative,” so I decided to wait until Tuesday to pursue the matter further. After rehearsing my questions a million times – as though preparing to represent the plaintiff in court – I called my insurance. I learned that the “narrative” is basically the diagnosis and treatment plan. The person I spoke to seemed very reluctant to provide useful information … almost as though it was against company guidelines… I noticed we were starting to repeat ourselves, so I ended the conversation before I could become so angry I’d be stuck dwelling on it for the rest of the day.

On Wednesday I called the periodontist’s office and spoke to a very helpful individual who not only clarified what happened, but forwarded me the email that had been submitted to my dental insurance. To be honest, I could see how they might have misinterpreted it: the file name for the attachment was “referral,” the form filled out was a “referral” form, and the periodontist’s office also offers general dentistry. I had to (wait for it!) read the content of the form to see that treatment was being requested. I was also able to verify that it met the criteria I’d been given for a “narrative:” two specific treatments were requested by name and reference number, and it was clearly indicated that I have “extensive bone loss” in the area. I’m not sure there is any additional information that would be relevant, except that I HAVE BEEN IN PAIN FOR SEVEN MONTHS MAKE IT STOP!!!!

This time, when I called my dental insurance, I immediately asked to speak to someone who had the authority to make a decision regarding my treatment. I was connected to a supervisor – who couldn’t authorize treatment, but could work with me more efficiently. I was able to be specific regarding the treatment requested, state that the x-rays and periodontal chart were included, and explain that it was on a “referral” form but was a request to cover treatment. The supervisor offered to call the referrals department, find out what they had received, and call me back.

On Thursday I received a call saying that they have the information I’ve been trying to convince them they’ve had for weeks!!! and it will be sent to the claims department on Friday. The supervisor suggested waiting until Wednesday to follow up regarding the actual decision.

For now I’m calling that a success – because if I don’t I’ll go even more crazy.

… But sometimes it’s a situation that I don’t have any control over and it’s not really worth following up on. Most of the examples I can think of have to do with disagreeing with someone on the Internet.

I think I got myself blocked from someone’s Facebook post … or maybe the whole post got deleted? Someone else had made a comment (tangentially related to the original post) about “transgender men” being allowed in women’s locker rooms at Planet Fitness; I interpreted it to be derisive. I felt compelled to clarify that the person in the women’s locker room was a trans woman and that Planet Fitness had defended her right to use the locker room that corresponds with her gender, free from harassment. Perhaps some of the (additional) points I made could have been worded a bit better. Perhaps some of my anger came through. It’s kind of hard to say; I can maybe see how part of it could be misinterpreted…

(Or I could be making a big deal out of nothing.)

At first I was able to see the post and all the comments leading up to mine, but there was an “error loading” at the bottom of the page. Then the notifications I had received regarding the post disappeared. The post no longer appears in my feed or where it was originally posted. It’s as though it never existed… which might be for the better, but it’s annoying the hell out of me!

I could private message the original poster, apologize for anything that was offensive, and ask what happened… but I’m not sure it’s worth it. We’re acquaintances who haven’t been in the same physical space for years; I’ve never even met the other people who had commented.

I think the best thing to do is let it go and move on with my life. Focus on something else. Do something else. I wish I could switch off the thought patterns that keep fixating on this relatively insignificant experience – or delete them. The post doesn’t exist anymore, so why should my memory of it?

But if I had an easy time letting things go and switching my focus to something else, I wouldn’t have written this blog post. Anyone have any ideas? What works for you?

To Lose a Tooth

I went ahead and had Root Canal Molar removed today. It was surprisingly straightforward: I went in and said I wanted the tooth extracted. They sent me for an emergency examination, during which the student dentist asked me about my previous visits, etc., then called the instructor over to review the case. It was the same instructor from the first time I’d been examined at this facility. He looked over the information, then said they shouldn’t have sent me to emergency and that he was going to expedite the process. (I assume he called my insurance.) Several awkward minutes later, I was on my way to oral surgery.

The instructor who examined me made some comments about “people sometimes change their minds” and “it’s a shame, all the other teeth are present” that were… awkward. Whatever her intentions were, it seemed to me like she was sticking her nose in my business and trying to manipulate me. I’m really not happy about having my tooth pulled; I would have preferred to save it. But the root canal just wasn’t viable; the endodontist couldn’t access the tooth well enough to do the work. And I couldn’t continue living with the problems it was causing. I needed to do something about it, and this was the option that was available to me. After living with intolerable pain for 7 months, receiving even this less-than-ideal treatment is a positive thing!

I won’t go into gruesome detail. Suffice to say the extraction was unpleasant and felt wrong on some fundamental level, like part of me was being ripped out… oh, wait, it was! I was pleasantly surprised that not only could I close my mouth during the procedure, it was actually beneficial and relieved uncomfortable pressure on my jaw. (I thought I’d have to hold my mouth open.) It didn’t take long at all; the assistant described it as “atraumatic.” When it was over I got to see my tooth, complete with some goo on the tip of the root that the assistant said was the infection. I felt relieved to have that out of my skull.

I felt a bit shaky and woozy immediately after the procedure, but I was glad to have it done. I became somewhat irritable as time went on, particularly because I had to bite on gauze to stop the bleeding and that was causing my jaw to hurt quite badly. Then the adrenaline and anesthetic wore off, leaving me feeling drained and in a lot of pain. It’s like a part of me is missing, and there’s a gaping wound in its place. (Actually, that’s exactly what’s going on….)

I eventually decided to remove the gauze; it seems to have stopped bleeding. I took some ibuprofen and am sipping warm black tea (without sugar). It’s very soothing. Now instead of an obnoxious dull ache that spreads from the area, causing jaw pain, ear aches, and headaches, I get to experience a wide variety of pain. The gum is irritated. The jaw is sore (but not particularly stiff – we’ll see how it feels in the morning). There is an occasional throbbing pain that’s sharper and more interesting than the dull ache was. The ibuprofen is taking the edge off, so I notice the pain but I’m not overwhelmed by it. Hopefully I’ll be able to sleep tonight.

It’s kind of ironic. Originally I didn’t even know there was a problem with Root Canal Molar. Especially when my gum infection worsened, I wanted Endangered Molar out of my mouth! But it’s still there, and (according to the dental insurance representative I talked to on Friday) the periodontal referral has been sent to a supervisor to expedite its review. Contrary to what they told me two weeks ago, my dental insurance received the referral on January 26th and just let it sit around for a month, while my jaw bone continues to rot. I should have a decision by tomorrow – something tells me I’ll have to call them to find out what it is.

My hope is that I’ll be able to receive treatment and get to keep that tooth. Now that I know what it’s like to have one tooth missing, I really don’t want to lose two right next to each other! But, in the end, there’s only so much we can do. “What will be will be” and all that.

Medical Update

I ran out of Lamictal because my appointment with the APN on Friday was cancelled for reasons outside my control. The receptionist said the “other doctor” would refill my prescription that day. Nada.

I called today around 11am and the same receptionist said the APN would take care of the prescription within the hour. “I’ll call you.” Four hours later, no call. I called back at 3pm and she said “by the end of the day.” I had important things to do today, so I couldn’t sit around waiting for it. But, according to the voicemail I just listened to, it’s waiting at my pharmacy.

I called my dental insurance to find out if there was any update regarding my periodontal referral for my Endangered Molar. I had received authorization for a consultation only; the periodontist (whom I saw on January 22nd) had to request authorization to actually treat me.

The dental insurance representative said they hadn’t received any such request from the periodontist! It’s been almost four weeks! And to make matters worse, she tried calling the office three times and kept getting a busy signal. She said she’d leave a note for someone to try again later.

When I’d met with the periodontist, she seemed to be on my side. They said “we’ll call you to make an appointment,” so I was a good patient and waited. They made it seem like any delay would be because of the insurance. I trusted them! I feel betrayed.

In related news, I went to get a root canal on Root Canal Molar last week. The endodontist-in-training attempted to perform the root canal, but had difficulty accessing it for several reasons – including but not limited to my inability to open wide enough for her to reach the back top of my mouth. Apparently the tooth is also rotated toward my cheek, making it even harder to access. We both put in our best effort, but all she really ended up doing was beating me up.

We’re officially at 6 months since I started having unbearable toothaches, and I still have yet to receive treatment! The bone damage near those teeth keeps getting worse; I can see it as a growing dark area in the x-rays.

I have an appointment to go back and try the root canal again… In two weeks… But I’d really rather not. We’ll need at least a couple of painfully long visits just to complete the root canal, then another 2 or more for the crown – if it’s approved – and there’s a chance I may have a problem with it later and have to come back again…

No, just no! That’s not happening! I’d rather just get the damn thing pulled and be done with it! I don’t even want to replace it with anything.

So now I have to convince the endodontist-in-training to refer me for an extraction and wait for that to be approved… I just hope I can communicate with her directly – and that she’ll follow through in a timely manner – without jumping through a million hoops. I can’t tell you how often I’m tempted to try and pull both teeth out myself!

But wait, it gets better! The sleep study that contributed to my crisis two weeks ago failed to reveal whether I have sleep apnea! The doctor had called me to discuss the study and, when I told him I’d slept much worse than usual, suggested we try an in-home study. I agreed and he said someone would contact me to set it up…

I was just thinking it was time to call them and find out what happened, when I received a letter from my insurance company saying they were terminating treatment by an out-of-network provider. The letter didn’t say what treatment; in fact, there is a sentence that doesn’t make any sense because the [insert colourful phrase in gorram Chinese here] who prepared the form letter didn’t bother adding what I consider the most important information! The only clue I had was at the very end: “cc Obnoxious Sleep Center.”

I was very worried that they would turn around and make me pay for the on-site sleep study (that had proven to be a waste of time and fucked up my head). I had trouble focusing on other things all weekend, I was so angry! I hated the insurance company for sending me an unedited form letter – instead of calling me to address the issue and offer help. I also suspected the sleep center of lying to me, billing my insurance for treatment I hadn’t received, etc. In short, it all made me feel very unsafe.

I called my insurance about the letter today. It had been intended to inform me that the in-home sleep study was denied because they don’t think I need out-of-state treatment. I explained that I wouldn’t be treated out-of-state, both the sleep center and my home are in the state that’s currently paying for my healthcare. But apparently the company (parent company?) that would ultimately receive the funds is based in another state. My results might have to be processed in another state, etc. To be honest, I understand why they wouldn’t want to pay for that. I just wish they’d told me in a more straightforward way!

The doctor who is ostensibly treating me was and may still be trying to get the decision reversed. As far as I’m concerned he’s welcome to continue (or not); I’ll follow through with whatever works best for me. I now have a list of names, addresses, and phone numbers that may or may not be accurate contact info for in-state sleep specialists.

I’d almost rather not even bother! But if I do have a sleep disorder, treating it could go a long way toward helping me function better in my daily life. I need all the help I can get – especially with two emotionally-intense graduate-level classes. I just need to consider whether trying to access treatment is worth the disruption it’s causing to my everyday life…

I’m considering the possibility that I might be better off going untreated, at least until my classes are over. Then I don’t have to play phone tag, listen to musak while on hold, reschedule my life around appointments that only add to my difficulties, and constantly feel like I’m beating my head against a wall. I estimate that more than half of my current stress would be eliminated if I weren’t trying to access healthcare (particularly dental) at this point in time. I kind of need to stay on my psych meds (I think), but perhaps the rest of it should be put on hold.

On a much more positive note, I took some steps toward finding a potentially-therapeutic group experience today. I met with the leaders of the “coming out” counseling group and told them that I’m trans*. They admitted that they’ve been having trouble finding members and expressed concern because the couple of clients they do have are cis, coming out as lesbian or gay. They would want to have at least one other trans* person in the group so there would be someone I could relate to on that level.

I appreciate that, even though it is a bit disappointing. At least they’re willing to work with me to find a group that might work, whether it’s the “coming out” one or another focused on general interpersonal issues. I expressed my interest in the latter and they said “if you don’t hear from us in two weeks, give us a call.”

They also encouraged me to join the extracurricular LGBTQ+ group I’ve been considering; that helped me overcome my reservations and actually show up for it today.

The facilitator was sitting at a table, surrounded my empty chairs. I walked over, said “my, what a lively group we have today!” and sat across from him. We talked for a bit about random things (completely unrelated to sexual orientation and gender identity) and had several awkward pauses.

Then he asked what I was hoping to get from the group. I told him I want a safe place where people will see me as I am: queer. He said that’s exactly what he intends for it to be, and what it had been in previous weeks when people actually showed up. His words were welcoming, but he seemed skeptical regarding whether he would see me again.

I think I’m actually more encouraged to return than I might have been if there had been a group. I felt like I bonded with the facilitator, and that makes me want to come back. I felt safe there; knowing it’s a safe place will make it easier to be there as part of a group. I feel less like I’m inserting myself into someone else’s party and more like I’m helping to establish the group. Next week we’ll be starting on the same page.

To Save a Tooth

“How can someone so young and healthy have such a serious problem with their teeth?”

The endodontist (root canal specialist) actually asked this during our meeting today – after I’d described a previous dentist’s theory that over a decade of grinding my teeth had caused a cavity to form inside one of my molars. It had decayed from the inside out, to the point where I almost needed a root canal when the cavity was finally detected about a year ago. I thought the dentist had fully treated it, but he only inserted a temporary filling. Some miscommunication must have occurred because I didn’t realize any follow-up was necessary.

Now my gum is badly swollen from an infection – that came back worse after I’d finished the antibiotics I was prescribed four weeks ago. It’s actually less painful now, but still very uncomfortable and so sensitive to the touch I can’t brush my teeth the way I’m used to. I feel like I have a bean wedged between my gum and cheek, and my jaw is sore on that side. I really miss being able to chew on both sides of my mouth and I’m concerned about how a gum infection might affect my overall health.

The endodontist couldn’t have performed the root canal with the infection there anyway, but he pointed out a bigger problem. I’m in danger of losing the molar next to the one that was supposed to receive the root canal because it’s the one that is infected. Ironically, the endangered molar is the one I thought needed treatment; my only complaint about Root Canal Molar is that it feels weird when I touch it with my tongue because it’s the very back tooth and I think half of it is missing. No pain; food gets stuck back there sometimes but I get it out with floss, everything’s fine. Apparently it might actually need a root canal or I could lose it, but again, there’s a much bigger problem.

My poor Endangered Molar has been assaulted by an alien civilization for at least the past two months! In addition to the gum infection, there is evidence of significant decay in the roots, possibly bone? I am in serious trouble. I really need to receive treatment for this … well, apparently, about a year ago.

The endodontist is not qualified to deal with gum infections, and is not authorized to give referrals to see a periodontist (gum doctor) or oral surgeon. So, I had to go back to my primary dentist in order to take further action. I was so furious, I was ready to start destroying things. When we got home I saw that Dog had gotten into my kitchen garbage! I was so angry, I told Mom to take him upstairs so I wouldn’t kill or seriously injure him. It was terrifying and so frustrating because I didn’t have a safe, socially acceptable way to express my rage!!!

I called my primary dentist and learned she could see me if I arrived within the hour. Within about 5 minutes Mom was driving me there; we arrived just in time. She asked questions and took X-rays and said I had two options: I could go to the periodontist to try and save the tooth, or I could go to an oral surgeon to get it pulled.

To be completely honest, if money weren’t an issue I’d say pull the fucking tooth, clean out the infection, and give me an implant. But implants aren’t covered by insurance and can cost up to $3,000. That’s more than my wedding dress! I could get the tooth pulled and not get an implant; this might be what I end up needing to do, anyway. I don’t think a bridge would be an option due to the location of the tooth; the dentist didn’t mention it as one.

But everyone – by which I mean the dentist and my mom – seems hung up on “but you’re so young!” and “it’s really better to keep your own teeth.” There’s a chance a periodontist might be able to help me, so it’s best to take that chance and get the tooth pulled only if it doesn’t work. I expressed some uncertainty, so the dentist made the decision for me: we’ll try the periodontist first. This way the dentist doesn’t have to feel guilty (I don’t think I’d feel any guilt, sorry Endangered Tooth – regret maybe if I then experience problems, but not guilt) and I might get to keep my tooth until I’m old enough for extraction and replacement to be okay. I’d need to wait for the antibiotics I’m now on (again) to kick in and (hopefully) clear the infection before I could go to an oral surgeon, anyway.

Here’s the really fun part. I could get an emergency referral to see an oral surgeon, but my insurance doesn’t see gum infections as requiring emergency treatment. They wouldn’t approve the emergency periodontist referral over the phone; there’s a chance they might not approve it at all! I have to wait 2 to 3 weeks before I’ll even know if I can see the periodontist, never mind then having to make an appointment! The infection will probably come back and/or get worse in that time, and who knows? Maybe more of my teeth will be in danger.

The receptionist said I have to wait for the referral to come in the mail, but if I had X Better Insurance she could write a referral and hand it to me.

Pissed doesn’t even begin to cover it.

You might be wondering, what do dental issues have to do with mental health? Well, let’s see.

1) “How can someone so young and healthy have such serious problems with their teeth?” Well, sir, perhaps my health issues are not readily apparent because they aren’t medical, in the sense most people are used to. I have mental health issues, which impact physical health as well. In my case, they clearly affect my dental health! For example, I GRIND MY TEETH!!! due to chronic tension from repressed anger and overwhelming anxiety.

2) I’m not working because my mental health issues are severe enough that I can’t even follow through with a job interview. I don’t trust my mood to be stable enough for me to show up for work consistently, and my anxiety levels to be low enough to function once I get there – assuming I can manage to be on time. Wakana would say I’m being too hard on myself and I should focus on the times I have been punctual and consistent. But I don’t have to do it every day; when I have had to do it every day I’ve struggled. I need help getting to the point where I can try it again.

Anyways, not working means no income means I can’t afford better insurance or to just pull the fucking tooth already and give me a titanium implant.

3) It’s really hard to do things like stand up for yourself to make sure you get the best possible care, drag yourself to the dentist and wait Spock knows how long hoping you’ll get seen as an emergency patient even though you don’t have an appointment, and deal with the stress of going to the fucking mall to see an overbooked dentist with staff that is probably overworked and underpaid and sick of being the person patients get angry at when their insurance is being sadistic. It’s even harder when you have mental health issues (especially being more attuned to other people’s needs and emotional states than your own). I would rather pull my own tooth without so much as taking ibuprofen first, than deal with the headache that is going to the dentist!

Hmm…

4) When you have a mental illness(es), you start to rely more on other people’s judgment; sometimes you trust it more than your own. “Maybe I thought he was being a jerk because I was wearing depression goggles.” “Maybe the chest pain I’m experiencing is from anxiety.” “Maybe I’m having these symptoms because I read that they’re potential side effects of the medication I’m taking.”

I know I can’t always trust my thoughts and feelings because they tell me things like “nobody loves me” and “I can’t do anything useful” and much, much worse. I rely on people reminding me that those things aren’t true and encouraging me to think about situations from other, more creative, and generally more positive perspectives.

So if you’re in a situation like I was last week, when the hygienist who did my cleaning said the pain I was experiencing from my infection was “normal,” it can seem a bit “crazy” and “excessive” to insist on seeing the dentist anyway. They were busy, I was feeling overwhelmed, I didn’t want to be on antibiotics again anyway, and I’d just been told that my problem was no big deal. So I left. If I’d stood my ground (or had someone advocate for me like my mom did today) my gum might not be swollen. I don’t know if my teeth would be in any better shape, but at least I could brush them!

5) Extremely frustrating situations like this can trigger all sorts of painful, unhealthy, and outright dangerous thoughts. It’s even worse when the people who are supposed to help me when I have a serious health concern like this either don’t seem to care or care but can’t do anything because of bureaucratic red tape. I’m fortunate that I’m in a place where my primary concern is protecting my health, and that my mom was able to support me in expressing my anger – probably because she was angry and worried too.

I’m furious to think that I can’t get the help I need because of a rule my insurance company made up, that someone who has never even met me has to review my information, make a decision with more concern about the company’s bottom line than my health, and use fucking snail mail to communicate with me. It can be all to easy to internalize that ruthless capitalistic complete and utter lack of compassion, to absorb the message that I am worth less than someone who can afford to pay for a better insurance plan (or worse, unworthy of medical interventions, period). So for now I’m clinging to my anger like a life preserver; the hard part is doing that while keeping it directed away from myself.