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!

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.

Take Women’s Health Care Out of Employers’ Hands: The Hobby Lobby Problem and the Single-Payer Solution

I really love the underlying point made in this post: “healthcare is an essential and public good.” In the US there’s too much focus on individual economic growth; I find it kind of terrifying that healthcare is a for-profit sector people (well, the small percentage who still have extra resources) can invest in for their own private economic growth. This article is great because it reframes healthcare as something we all as citizens can invest in for the health and well-being of ourselves and each other. That’s what a single-payer system should ultimately be: not putting healthcare in the hands of a nameless, faceless “government” that is ultimately run by big business… but taking it out of the hands of big businesses (including private, for-profit insurance companies) and back into the hands of we, the people.

Healthcare Update

The system might be effed up, but there are people in it who can be pretty awesome. Not long after my last (April 11th) post, I received a voicemail about my health insurance application with the state. I’d gotten fed up with the Healthcare.gov website and applied to my state’s program directly; when I finally received coverage under my birth name I didn’t ask any questions.

Anyways, I called the person back hoping he could resolve my name change over the phone. We played phone tag a couple of times, but within about 2 hours he said he had taken care of it. I received a piece of paper a couple of days later saying I, [my married name], do indeed have health insurance through the state. That man saved me a trip I really didn’t want to take. He’s my hero!

And it gets better. My and Fox’s primary care provider (PCP) is a short walk from our home. It’s a small practice shared by a couple of doctors, a nurse practitioner, and a friendly-professional staff. I didn’t get to see the doctor who’s listed as my PCP, but that’s okay because I really like the nurse practitioner. She prescribed an anti-inflammatory for my upper body pain and suggested I have a sleep study done to see if I have sleep apnea; they should call me by Thursday to set up an appointment. I asked to have blood work done; the nurse who drew my blood was courteous, respected me and my knowledge of my own body, and caused me minimal pain. I left feeling quite good about the whole experience.

The one downside is that I’m still not sure if I need a referral to see a psychiatrist; the nurse practitioner didn’t think I should but suggested I call my insurance to be sure. If I need one I just need to call the PCP and the staff will get me a referral, no problem. Well, that’s a relief!

Back on the Healthcare (Headache) Bandwagon

Wakana has been urging me to see a psychiatrist, so I’m finally starting to move in that direction (now that I have health insurance, thanks to the Affordable Care Act). I found a local psychiatrist in my plan, but I think I need a referral from my primary care provider to go see her. I was concerned because my healthcare ID cards have my birth name on them, but I’ve updated my social security and driver’s license to reflect my married name. I don’t want to be denied healthcare because of the inconsistency.

So I called my HMO, and had to talk to a machine, and finally got to talk to a person, who gave me a number I’d already tried and gotten a busy signal, then transferred me to an automated health screening. (The person was nice and as helpful as possible, given the bureaucratic red tape.) When asked to rate my overall health, I rated it as “fair” – but the other questions led me to think perhaps it’s a bit better than that. I don’t need the equipment or assistance they specified (though help remembering to take medications might prove useful, and I’d love to have someone come in and help me declutter on some kind of regular schedule). I only answered “yes” to one of the conditions mentioned: symptoms of depression. The thing is, there were no questions about the severity of my symptoms. The only other clearly mental-health related question was “Have you been diagnosed with schizophrenia?” There was no mention of bipolar, anxiety, PTSD, dissociative disorders, or other mental health issues.

After being screened, I tried calling the bureaucracy again and selected the option to talk to a human being. I was forwarded to an answering service, which then disconnected me because the mailbox was full. I don’t know if going through the automated service would have worked better, but think I would have been transferred to a human answering service disconnected anyway.

“Oh, well,” I thought. “I’ll just have to go there in person and deal with whatever stupidity awaits me. I’ll bring water, snacks, and a good book.”

Of course I didn’t feel up to it today. I was barely able to keep myself from crying while I was on the phone, and I’m sure some degree of distress came through in my voice.

The human being I’d talked to assured me that healthcare providers would accept my insurance as long as I had the relevant ID, even though the name on it doesn’t match the name on my state-issued photo ID.

So, I tried calling my primary care provider. Might as well make that appointment, right?

“The office is closed. Please leave a message after the tone.”

I think I’d rather go eat some ice cream…

The Healthcare Headache Continues …

I thought I had the answer: I would take a 3-credit course, in part out of interest and in part because it would make me eligible for my school’s “voluntary” part-time student insurance. But today I learned that there are no longer any part-time student plans available – whether that’s because my school dropped them, or the insurance company stopped offering them, I don’t know. I just know that I was very confused and frustrated when one part of the site still said I could opt-in to the voluntary insurance, but when I clicked the link it said no plans were available.

I’ve reluctantly accepted that they’re not offering insurance to part-time students, based on the mail-in forms having last year’s dates. They just didn’t bother to update the whole website. Lazy bums. (Acceptance doesn’t make me any less angry. It just saves me the trouble of trying the same thing over and over again just to be repeatedly disappointed by the results.)

I’m disinclined to trust the $400/month short-term insurance plan offered by an affiliate of my school’s insurance company. The very nice representative I’d talked to called back, reminding me to apply in time for coverage to start on the date I’d requested. She also re-sent the information she’d initially sent me. I’m tempted to call her back and thank her for her help. But the attached PDF clearly stated that prescriptions weren’t covered; when I tried to see if other plans were available, the one she’d recommended disappeared, so there were no plans available at all! I know I can call her back and ask questions, but I don’t want to risk wasting money (that I don’t really have) if the information she gives me turns out to be wrong.

In light of all this, paying nearly $2,000 to take a class purely out of interest became a lot less appealing – especially since a similar one might be offered for free on Coursera. I started listening to the lectures for one of my Coursera courses last night and found them to be positively fascinating. It felt so good to just soak in the information. No deciding what to wear, traveling, finding parking, potentially being late, awkward social situations, and consequences for not doing assignments required. So, I’ve decided to drop the 3-credit course I’d registered for at my school, and go the continuous matriculation route. A relatively small fee means I’m still a graduate student, really!

That still leaves the matter of health insurance.

I’ve decided against going to see a psychiatrist for the time being. The SAM-e (along with other factors) seems to be helping quite a bit, especially on days when I remember to take 2 doses of it (400 mg 2x/day, total 800 mg per day). It’s not perfect, but it’s at least as good as the antidepressants I’ve tried so far, with less adverse side effects (maybe because it doesn’t contain weird, unnatural chemicals?). It’s not exactly cheap, but I think I’m saving money over seeing a psychiatrist and paying for medication, especially if I need brand-name instead of generic. I can buy the SAM-e in 3 clicks and have it shipped to my front door – no phone tag, traveling, disclosing personal information to a stranger, and waiting at the pharmacy required. It might not be the best, but it works better for me right now. I can’t help wishing I’d found out about it years ago.

Health insurance suddenly seems a lot less important if it’s not the only way I can afford to treat my depression. Wakana doesn’t take insurance; I’ve been paying her at a discounted rate out-of-pocket. Insurance wouldn’t cover the SAM-e anyway. Hospitals are required to give life-saving care regardless of whether you have insurance. The only thing left is preventative care, which I’m hoping I can find a clinic for nearby. To my knowledge my state isn’t among the insane ones trying to shut down Planned Parenthood, so I intend to begin my search there.

(In case it’s not blatantly obvious, I hate going to see doctors. So, for most things, I wouldn’t bother seeing a doctor. If I’m miserable with a cold or something, I’d rather be miserable at home where I have access to things that help – like tea and soup – instead of at the doctor’s office.)

And in October I should be able to shop for an insurance plan on Healthcare.gov, so hopefully I’ll only lack health insurance until January. Hopefully.

Let’s be honest, I hate making these decisions. But this is the hand I’ve been dealt, and I need to do (or choose not to do) whatever it takes to protect my mental health. I’ve been burned by conventional medicine and the insurance required to make it remotely affordable, so I’m finding alternative ways to take care of myself.