Insurance said no

Today was heartbreaking.

After waiting six weeks just for my prior authorization to be submitted, and then another three weeks waiting for my insurance company’s decision, I finally got an answer.

Denied.

The surgery my surgeon recommended, a right TMJ disc removal with an abdominal fat graft, was denied as a non covered procedure under my insurance plan.

I wish I could say I handled the news well, but I didn’t. I cried. A lot.

The hardest part is that I just don’t understand. I pay for health insurance. I’ve gone to the appointments. I’ve followed the treatment plan. I’ve done physical therapy, taken medications, had imaging, undergone arthroscopy, and waited through months of referrals and prior authorizations. I’ve done everything that has been asked of me, and somehow the answer is still no.

I don’t understand how insurance companies get to decide what procedures, medications, or treatments are worth covering. The people making those decisions don’t have to live with my pain. They don’t know what it’s like to wake up every day wondering how much your jaw will hurt or whether you’ll be able to eat dinner without paying for it later.

It’s hard not to feel defeated.

Right now, I don’t even know what the next steps are. I don’t know if we’ll appeal the decision, if there are other options, or if this is simply another obstacle I’ll have to figure out. Financially, I don’t know what is possible anymore.

As the tears have started to slow down, what I’m left with more than anything is exhaustion.

I’m exhausted from living in pain.

I’m exhausted from not being able to enjoy simple things like singing in the car, sleeping through the night, eating foods that aren’t soft, talking without pain, yawning without pain, or even laughing without thinking about my jaw.

Living with TMD isn’t just about jaw pain.

It’s the uncertainty.

It’s the constant search for answers.

It’s the struggle to find doctors who understand.

It’s the insurance battles.

It’s the waiting.

It’s grieving the life you used to have while trying to adjust to the one you have now.

There have been so many moments throughout this journey where I’ve felt completely alone.

Today was one of those days.

Tomorrow I’ll figure out what comes next. Today, I’m just letting myself be sad. I’m letting myself feel the disappointment because this hurts. It hurts emotionally almost as much as it hurts physically.

I don’t know how this story ends yet.

I just know I’m not done fighting.

-Sabrina Kelley