United Healthcare defines surgery that would allow chewing and talking to be cosmetic

Source: Daily Kos

Anna Sacheen Parker was diagnosed with left side hemimandibular hyperplasia back in 2013. A more simple explanation is that her jaw has never stopped growing since she was born.

She has dealt with this her whole life, initially just insecure about having a “crooked smile.” But now, she can’t even use a spoon to eat anymore, making most of her food so that it can be eaten through a straw. “My jaw is so messed up,” she says. “None of my teeth touch and they’re getting pushed out.” Her misaligned jaw has made eating, speaking and even existing incredibly painful.

In an attempt to begin the process of “fixing” Sacheen’s medical situation, a maxillofacial surgeon performed a procedure in which he used cartilage from her ear to create a new disc in her temporalmandibular joint on the right side, allowing for more mobility. It was supposed to be the first of a lengthy 3- to 4-step process in correcting Sacheen’s issues.

But here’s where things get tricky. Because of the way the law is written in Oregon, insurance companies are not required to cover treatment costs related to the temporalmandibular joint (TMJ) or to pay for treatment of temporalmandibular joint disorder (TMJD). The reason for this loophole is that often TMJD is the result of a traumatic accident, usually a car accident. In those cases, typically someone’s car insurance would be held liable for the resulting medical costs. This is not the case for Sacheen, as her TMJD is the result of a genetic defect.

A spokesperson for United Healthcare provided a statement that they understand the challenges she has managing her diagnosis: “Our medical directors have reached out to her physicians to discuss her options, since her benefit plan does not include coverage for this type of surgery.”

Meanwhile, Parker’s friends have started a fundraising site to help her with medical costs. And Parker is learning sign language as one of those “options,” since she may not be able to speak particularly well in the future without the surgery.

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