Frustrated-insurance issues, wisdom teeth, etc.

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LMills
Veteran Member


Date Joined Apr 2008
Total Posts : 1753
   Posted 2/10/2009 8:47 PM (GMT -7)   
I went to have my wisdom teeth, originally supposed to be two, x-rayed so we could pull them out.
Now it turns out that there are four and need to be cut out(one is literally growing sideways in my gums). The surgeon said that I am high risk because of prolonged steroid use and the fact that I am 20 years old SO he wants to do the daylong procedure with the anesthesia in the main hospital so he can monitor -every single thing-. I suppose I am just a little bit tired of being high risk in any procedure I have to undergo. I can live with it, but I needed to vent. Of course this is assuming my insurance will cover it. They didn't cover the last anesthesia use for my ectopic pregnancy, but this is likely due to the fact that it was connected with that and the insurance didn't cover pregnancy issues at the time. My main worry is going on the antibiotics, but I know this is necessary so I can live with that too. I have really good probiotics anyway, and even if I didn't, my GI's nurse was told to tell me that I need to stay on one during that time.

Also, I went to the pharmacy tonight to pick up my prescription for omeprazole and figured I would go ahead and pick up my two humira pens. The pharmacists were going to get it until they noticed in the computer that my insurance no longer wants to cover humira and wants me on remicade instead.
My question?: How on earth is it legal for an insurance company to be the one prescribing medicine for a disease whose name they probably can't even spell? That is supposed to be a DOCTOR'S decision. Not only this, but is remicade not more expensive for the insurance to cover? And why would they want me to change medication that is obviously working unless the actually want to pay for me to stay in the hospital from being violently ill? Humira seems like the least expensive option, and it would save a lot of people from doing MORE paperwork.

Suffice to say I am irritated.
20 years old, Diagnosed with moderate to severe Crohn's and Colitis in May of 2008.
Currently taking:
Prednisone 5 mg, pentasa 2 pills 4x a day, bentyl as needed, omeprazole in the morning, prenatal multivitamin, humira every other week, and good probiotics.
Surgery for ectopic pregnancy most likely the result of severe Crohn's inflammation in July of 2008.
Attempting a diet without refined sugars, high fat content, bleached or bromated flour, most dairy, red meat, and avoiding anything spicy like the plague. Also refuse to eat anything with trans fat or high fructose/corn syrup.
"He who has a why to live for can bear with almost any how."


spookyh
Veteran Member


Date Joined Oct 2008
Total Posts : 1342
   Posted 2/10/2009 11:02 PM (GMT -7)   
My dental story, which ultimately, should encourage you smilewinkgrin:

I had my two upper wisdom teeth out at the age of 21. Piece of cake, they came right out. I didn't suffer from any swelling or pain like some people do, and didn't even need the pain meds.

At around 30, I decided it would probably be a good idea to get wisdom tooth number 3 removed (I was lucky, and there was no number 4). It was impacted, and growing sideways into the the tooth in front of it. It was also embedded in the jaw bone. Oral surgeon number 1 wanted to charge $1000 to remove it, and wanted me to be sedated and have an IV. They made it sound incredibly scary, and said I did not want to be awake for such an awful procedure. I chose not to have it done.

A couple years later, I saw oral surgeon number 2. He was only going to charge $180, and it was just going to be a regular dental procedure (no IV, no sedation, etc.). He said there were some risks due to prednisone and actonel use, but that it probably wouldn't be an issue. The biggest problem he foresaw was the potential for nerve damage (permanently numb tongue and chin) and jaw damage. So I had the surgery, and it was a piece of cake. I don't know why surgeon 1 tried to make it out to be such a horrid experience, because it wasn't. At least not until I got home and the numbness wore off. Then I prayed for death :-). The pain was just terrible, and at the time I wished I hadn't done it. It also took a long time to heal, but that ended up being because a piece of tooth "shrapnel" was left behind. One day, I felt something sharp poking out of my gums, reached back with a tweezer, and pulled out a tooth shard. After that, everything healed up just great. My jaw healed just fine, and the numbness in my chin went away with time (I was told it could take 9 months for the nerves to heal). I'm now glad I had it done, even though I was quite miserable for a couple of weeks. However, don't let the pain part of my story scare you. It was mostly due to my age. The tooth and jaw were very hard. If I had done the surgery at 20, like you, they still would have been soft and there would have been less trauma to the jaw bone.

This is my long winded way of saying you might want to get a second opinion. Things probably aren't as dire as your surgeon is making it out to be.

spookyh
Veteran Member


Date Joined Oct 2008
Total Posts : 1342
   Posted 2/10/2009 11:06 PM (GMT -7)   
My insurance will pay for remicade, but not humira. I developed a severe reaction to remicade, so it's not an option. I ended up applying to humira's patient assistance program, and they give me humira for free. You should look into it. Since you're already on humira, and are loosing coverage, they might accept you. Of course it will depend on your income as well.

caroline_r
Regular Member


Date Joined Apr 2004
Total Posts : 94
   Posted 2/11/2009 3:55 AM (GMT -7)   
First off all, it's sooo stupid they want you to go on Remicade!! They're not doctors! Those are similar drugs, but they're different. Needless to say that Remicade didn't work for you and Humira does, take a hint you -_ _ _ _ _ _ insurance company! Arrrgghhhh So not fair!! I hope you'll be able to solve this problem!

about the wisdom teeth...I just had an operation a month ago. I was under anesthesia and they got all 4 of them out. I'm on Imuran so my CD doctor was worried too and really wanted me to have the operation before switching to Remicade/Humira. It was like "You can't have that surgery under R or H!" so I was really really scared as hell and wanted to get it over with in order to start with H/R finally. I'm really sorry because I know you'll be even more scared after I've told you this. Your doctor's worried about the steroids, and I'm worried about the steroids AND Humira. It's not going to be easy!

Ok, so I'm going to tell you how it went for me. The surgeon that took my teeth out heard about CD but I have to say he had no clue whatsoever!! I had to write them a paper that said which meds I was taking and then I wrote that I'm on metronidazole and that my doc said I should continue taking it because it was good for the teeth too. I asked them to get it IV and I also told them my doc said it was ok to take this other antibiotic too but IV. So they gave me metronidazole and that other antibiotic 3x a day for 5 days. The thing is that I knew it was going to be hard to recover since I have CD and I take Imuran, and that's why I asked them to stay at the hospital longer. They were going to release me the same day and I had a fever, got my period due to anesthesia, threw up blood 5 times (I guess a lot of it went down my throat during the surgery). The worst part was the pain and not being able to eat. If they had sent me home I don't even want to think what would have happened. Us Crohnies have malnutrition anyway and to have to take two antibiotics at once 3 times a day on an empty stomach with active CD NO THANK YOU!! I lost weight, I am now even more anemic than I was. Oh and I got a B12 shot a few days before the surgery cuz it helps iron to work better and because I was on metronidazole anyway which sort of kills B12 so...

My advise to you is to do everything you can to stay at the hospital as long as you don't recover. It's going to be a hard recovery especially because you're on Humira. God forbid that you get postoperative complications on your jaw (and it is possible) - I'm not trying to scare you. I was warned about this before the surgery. It's getting 4 teeth out! For a healthy person it would be hard to recover, let alone for us! So don't panic over the antibiotics they're going to give you. Antibiotics will help you! I know I'm probably not supposed to tell you that they should give you metronidazole (a normal antibiotic for CD) but I know it's helped me a lot after the operation, it's good for your intestines (unlike other antibiotics) so maybe you should just ask your doctor what he thinks.

I was swollen for about a week. My right side looked and felt worse. But honestly, I thank God I got two antibiotic 3x a day through IV cuz without it I think I would've been in big problems. Imagine taking 2 antibiotics 3 a day orally on an empty stomach ( i know, I've already said it)! Plus IV works faster and has a much much bigger effect! Oh and I drank a lot of Ensure since you don't have to chew it and it has a lot of vitamins in it,etc. What else, what else...I don't know.

Let me know if you need more information. I hope everything goes well. Just try get your doctor to give you the antibiotic/s IV and keep you there till you get better. I'm glad he's so worried, it means he'll do everything he can do to get you through this. I even had to tell my surgeon to do the blood works...yeah, it's great to have to teach doctors shocked

Oh and I got a painkiller IV too. Every 8 hours. Worked like a charm! ;) Oh and when I woke up it was painful but it gets better. Just put a lot of pillows below your head because it's really important that the blood doesn't go up to your head - it'll hurt more, etc. Keep your head up at all times - like when you're in the bathroom - don't look down! I think that's about it...

Keep us posted!

P.S. I hope that you'll have some use of my experience. I know was really scared as hell...

P.S. 2 If you throw up the first day, after drinking water or tea or ensure or whatever, don't panic! It's good that you try to get as much of water, tea, whatever in you so that all the blood that's possibly in you gets out of you stomach. It wouldn't be good if it went down your intestines...so throwing up blood is good!
21 yr. old with crohn colitis. Diagnosed in March 2004. No surgeries so far.

Post Edited (caroline_r) : 2/11/2009 4:02:32 AM (GMT-7)


gachrons
Veteran Member


Date Joined Mar 2007
Total Posts : 4527
   Posted 2/11/2009 5:48 AM (GMT -7)   
Hi Your right about insurance companies making decisions for people and going over Dr.s heads .I guess they must have a medical degree that is far more advaced then a GI's ...A lawyer should be cracking down on cases like that ,and probably would if people took them to court... as it interfears with patient care..lol gail
Hallarious woman over 50 ,CD ,IBS 27 years--resection,fistula's,obstructions,hemmies,and still alive.lol gail


LMills
Veteran Member


Date Joined Apr 2008
Total Posts : 1753
   Posted 2/11/2009 4:05 PM (GMT -7)   
Gail-I guess so. They must know every detail of our diseases and the medication we take. Seriously!

caroline-....that sounds like a lot to look forward to....

spooky-I will definitely look into that! I already am qualified for the copay assistance program so they were supposed to cover that, but since I don't even have the copay anymore based on the insurance company's decision, it's a little bit pointless right now. I will be keeping the other in mind though thank you :)
20 years old, Diagnosed with moderate to severe Crohn's and Colitis in May of 2008.
Currently taking:
Prednisone 5 mg, pentasa 2 pills 4x a day, bentyl as needed, omeprazole in the morning, prenatal multivitamin, humira every other week, and good probiotics.
Surgery for ectopic pregnancy most likely the result of severe Crohn's inflammation in July of 2008.
Attempting a diet without refined sugars, high fat content, bleached or bromated flour, most dairy, red meat, and avoiding anything spicy like the plague. Also refuse to eat anything with trans fat or high fructose/corn syrup.
"He who has a why to live for can bear with almost any how."

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