insurance denial - help!

[Guest guest]

Cigna has denied my upper and lower jaw surgery (anterior open bite)

NOT on grounds that it isn't a significant skeletal deformity. They

concede that point. But they say I haven't demonstrated that it is a

" significant functional impairment. " Of course, I'll appeal. My

question to any of you is, what advice would you give for

demonstrating significant functional impairment to Cigna?

The following is true: I developed severe jaw fatigue over the past

couple of years, which has limited and changed my eating habits. It

makes it harder to get through meals, and it definitely limits the

food that I will even attempt to eat. I'm not choking on every bite,

but I do think I -- at times -- swallow pieces of food that are not

chewed as well as they should be. And my braces have made my bite even

worse.

And I know my molars have worn excessively. I've had to get filling

after filling, crowns, etc., and I floss and brush compulsively, keep

my teeth immaculately clean, so I know my teeth aren't decaying on

their own.

I also have had problems with not being able to open my mouth wide,

popping jaws, headaches and all the rest, but I'm not going there with

Cigna because they exclude TMJ.

It makes me very angry, because the symptoms/effects of my open bite

are definitely getting worse the older I get (37), and just imagine

when I'm in my sixties or seventies, when arthritis and all the rest

really kicks in. What am I supposed to do, resign myself to a diet of

oatmeal and bananas? Why not get the problem fixed now? The older I

get, the harder the recovery period from surgery will be, as well.

I can't imagine that having eating difficulties and worn-down,

banged-up teeth isn't significantly impairing.

As far as cosmetic concerns go, I won't even get much of that with

this surgery, unless I have a genio, which insurance won't cover, and

I'll have to pay for myself. So it's not for cosmetic reasons.

Any advice on proving my case would be greatly appreciated.

Thanks,

Amelia