Is this right - Gunson/Arnett

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SantaBarbarian
Posts: 15
Joined: Tue Apr 05, 2016 1:18 pm

Re: Is this right - Gunson/Arnett

#31 Post by SantaBarbarian »

[quote="maxhammer"]Does anyone know if Dr. Eric Wallace in Santa Barbara is good?[/quote]

This is almost certainly way too late to help the questioner, but I met with Dr. Wallace once. He was recommended by Barbara Greene, a myofunctional therapist in Santa Barbara, who thought I might have a tied tongue due to a shorter than normal lingual frenum. I trust Barbara Greene - she's an excellent provider, and Dr. Gunson thinks she's phenomenal at what she does as well. I do not know if Dr. Gunson has an opinion about Dr. Wallace.

After Dr. Wallace's examination, he said I definitely had a tied tongue and that I should have surgery. I checked around and the surgery cost $500-$800 depending on where you go (to be fair, he was on the lower end of cost). I decided to consider it but to first try some exercises with Barbara Greene, as I was going to do those anyway, and there was a chance it could get resolved through exercises. Turns out, exercises to stretch out my tongue were all I needed - they completely fixed my problem within 1-2 months, and corrected a few other issues as well (e.g., it reduced, but did not eliminate, my sleep apnea - my apnea was just too severe for this to resolve it alone).

So, I was left thinking that Dr. Wallace is either surgery-happy or that he just doesn't know how incredibly valuable myofunctional therapy is (which is surprising because he works with Barbara Greene all the time).

Dr. Wallace (or his office staff) also billed the wrong procedure code to my dental insurance for the examination. He/they coded it as if I came in for a six-month checkup and cleaning. This wasn't a problem until I went in to my regular dentist for a checkup and cleaning and then the insurance rejected my regular dentist's bill (leaving me to pay the cost). Trying to get ahold of Dr. Wallace and his staff to tell them that they billed the wrong code, and then to get them to fix it, took far more effort than it should have taken.

In the end, I walked away without a very favorable opinion of him, though I did like him during the consultation itself.

My orthodontist is Dr. Dawn Thatcher and she is wonderful. I see Dr. Dart, located in the same building as Dr. Thatcher (but a different office) for general dentistry needs. I've also had experience with Dr. Wipf for sleep dentistry needs (he made an appliance to pull my jaw forward and also customized a CPAP mask for me, though in my case neither was a good long-term option). Dr. Wipf is also in the same building, but a different office, as Dr. Thatcher and I think highly of him as well. This building is located just around the corner from Dr. Gunson's office, making it all very convenient too!

mrkdilkington
Posts: 11
Joined: Wed Mar 30, 2016 4:19 pm

Re: Is this right - Gunson/Arnett

#32 Post by mrkdilkington »

Hi SantaBarbarian, thanks for your post, it's extremely helpful as I'm getting ready to have surgery with Dr. Relle (also out-of-network) in Los Angeles this summer for sleep apnea/uars & anterior open bite. I'm around the same age and build as you, and still wake up many, many times per night on CPAP. How were your results with respect to your sleep?

SantaBarbarian
Posts: 15
Joined: Tue Apr 05, 2016 1:18 pm

Re: Is this right - Gunson/Arnett

#33 Post by SantaBarbarian »

Hello Mrkdilkington!

Sorry, I didn't see your Q until just now.

I think I may have posted some recovery info on another thread. This is getting a little off-topic on this thread and I'm not familiar with all forum rules, etc., but in the effort to be helpful, I can say hands-down that this surgery is/was a life-changer. My wife says I no longer snore at all at night and I feel more refreshed, alert, and awake throughout the entire day on 7 hours of sleep than I did before on 9 hours of sleep. Except for fighting with my insurance, I'm a much happier, more patient guy and I feel so much more like my old self. And this is with me still recovering. Case in point: today, 22 weeks after my surgery, Dr. Gunson cleared me to eat regular food (with the admonition to start slow, which is fine with me - my front teeth are still too sore and I wouldn't want to bite into a burger anyway, but I'll happily cut it with a fork and knife and chew now that I'm allowed to do so!).

In the past month, I've started running again. I never enjoyed running before, but it is/was a relatively easy way to get exercise - throw on some shoes and go. Every time I've gone out, I've set a goal that is deliberately low because I don't want to push myself too far. And every time, I've blown way past my goal because it felt that good to move. Specific examples:
-The second time I went for a run, my goal was just 3 minutes of light jogging. At 90 seconds into it, I thought "Hrm, I could turn back now and be done having met my goal, but no way do I feel like turning back right now!" I ended up moving for about 15 minutes total, and I think I was jogging for about 12 of them. This was about a month ago.
-Just yesterday, I decided to go for a 1.5 mile jog. I didn't intend to jog the entire time, and I didn't actually jog the entire time, but I did jog far more than I'd expected and at a faster pace than I'd anticipated. Considering that I've been pretty layed up because of the surgery, I was shocked to see that I'd run a 10-minute mile without trying that hard. And then I was even more shocked to find that I'd run a second mile (instead of an extra half-mile like I'd intended) and that I'd also run it in 10 minutes too!

While these are not shocking times for "real" runners, let me put this in perspective: I trained for a short, sprint-triathlon four years ago. Even though I was that much younger, it took me probably a month of training to get to a point where I could comfortably run 2 miles in 20 minutes. Yesterday was four months exactly after my major surgery and I did that having only ran a cumulative total of five miles through five different runs in the past month. This just blows me away and makes me so excited for what is to come.

I 100% credit this amazing change to my larger airway and being able to actually get real sleep. Before the surgery, one of Dr. Gunson's staff said that patients often report that they can breathe easier after surgery. I remember being skeptical and asking if she could elaborate, because I didn't feel like breathing was difficult. Even looking back, I still don't feel like breathing was difficult, but these results speak for themselves. And, I know I'm running with better posture, because I no longer need to (subconsciously) hold my head forward to try and open my airway.

Did I mention that, before the surgery, I had a sleep study done at Stanford that showed I had only 8 minutes of REM sleep in a 9-hour sleep period? And that particular night was the first time that I ever took a prescription sleeping pill, and I felt more refreshed the next morning than I had in YEARS, which indicates that under normal (non-drugged) nights I would get far less than 8 minutes of REM the entire night? I'll have another sleep study at the end of the year to (hopefully) prove the apnea is CURED (i.e., an AHI of less than 5, vice "surgical success," which in medical literature is defined as "reducing to an AHI of 15 or less OR cutting your AHI in half" - I personally would not define cutting my AHI of 40+ down to 20 as a "success," I wanted a CURE!). So I can't say with certainty that I'm cured, but I think I might be.

To be fair, without medication, I do not wake up on a daily basis feeling as refreshed as I did that one night at Stanford, but apart from that, this surgery has been LIFE CHANGING, is worth every penny, will extend my life with my family for at least a decade (maybe two or more even?) , and will (and already has) dramatically improved the quality of ALL of it.

It's an incredibly scary surgery for the patient and recovery is absolutely awful. Check out my blog which has more details by searching for "Chris's Jaw Surgery 2015." And it didn't all go smoothly - there was about an hour 5 days after the surgery where I could barely breathe (we figured out how to effectively make a snorkel for me which I then used for two days). I also had a nerve accidentally severed and sensation on the left side of my chin is only just now beginning to come back and I'll be very lucky if I get 50% recovery in that area. But it was all 100% WORTH IT.

I believe there are many capable surgeons out there. I am not familiar with the name of your surgeon, but that's not a terrible thing. I just strongly advise you get more than one opinion. I loved the surgeon I initially was working with at Stanford and it didn't work out (long story) which made me finally meet with Dr. Gunson. He used a different approach and took amazing pains to be careful about my extremely thin maxilla (which the Stanford Surgeon never mentioned). So even if you are thrilled with your surgeon, I still advise getting another opinion if you haven't done so already.

Good luck - I wish you the best!

BrooklynsOwn
Posts: 36
Joined: Wed Jul 01, 2015 8:54 am

Re: Is this right - Gunson/Arnett

#34 Post by BrooklynsOwn »

SantaBarbarian your teeth still hurt 22 weeks after surgery??? Isn't that a long time? Will the pain ever go away?

SantaBarbarian
Posts: 15
Joined: Tue Apr 05, 2016 1:18 pm

Re: Is this right - Gunson/Arnett

#35 Post by SantaBarbarian »

[quote="BrooklynsOwn"]SantaBarbarian your teeth still hurt 22 weeks after surgery??? Isn't that a long time? Will the pain ever go away?[/quote]


Hi BrooklynsOwn,
Let me clarify. My teeth don't hurt just sitting here; it's when I put pressure on certain teeth that I feel some soreness, and I think this is largely (probably entirely, but there's no way for me to know with certainty) due to ongoing orthodontic work.

When I started this process, my teeth were far from being perfectly aligned. I had orthodontics for a decade growing up when I was a child (they tried to make room but could not make enough room, eventually had to have surgery to remove teeth to make room which then required more orthodontics to close that gap), but despite that, my teeth must not have been perfectly aligned (or I needed to wear a retainer at night for the rest of my life and was not given one) and over the course of over 1.5 decades, they shifted so that they were far from properly aligned. Even if they were properly aligned, the fact that my upper jaw and lower jaw were moved forward different distances (10mm and 17 mm, respectively) meant that they wouldn't be properly aligned anymore after the surgery. Hence, a lot of orthodontic work. Because my sleep apnea was so severe, everyone agreed it would be better to operate before the orthodontic work was complete.

And yes, moving teeth around will make them sore, depending on how big the movement and how fast it's done. I'm also sensitive to cold drinks. That's common post-surgery but is also possible with orthodontic work.

It was anticipated that I would have to continue orthodontic work for at least a year post-op to complete everything. At this point, six months later, it's still possible to complete the orthodontic work within 12 months but the schedule is getting tighter. My teeth just are not as cooperative as the average person's. Dr. Gunson and my orthodontist are working together to devise ways to speed it up so that maybe we can keep to an ~1 year timeframe.

Who knows, maybe the new approach will work so fantastically that I'll be braces-free in December or earlier!

SantaBarbarian
Posts: 15
Joined: Tue Apr 05, 2016 1:18 pm

Re: Is this right - Gunson/Arnett

#36 Post by SantaBarbarian »

P.S.

It is now well-known that the approach my dentist used as a child to treat me (eventually pulling teeth to make room) is the exact wrong approach to use and causes the entire jaw/teeth to fall inward, substantially worsening any sleep apnea problems that someone might be prone to have due to an underdeveloped jaw. I've been told there's an entire generation of people like me that grew up in the 80s (probably 70s and 90s, too, but I can't speak to that) that are now having this type of surgery to correct those problems.

And the saddest part? I've also been told that there are some orthodontists out there that are still treating patients the way I was treated in the 80s. We didn't know better then, but we do know better now!

BrooklynsOwn
Posts: 36
Joined: Wed Jul 01, 2015 8:54 am

Re: Is this right - Gunson/Arnett

#37 Post by BrooklynsOwn »

SantaBarbarian wrote:P.S.

It is now well-known that the approach my dentist used as a child to treat me (eventually pulling teeth to make room) is the exact wrong approach to use and causes the entire jaw/teeth to fall inward, substantially worsening any sleep apnea problems that someone might be prone to have due to an underdeveloped jaw. I've been told there's an entire generation of people like me that grew up in the 80s (probably 70s and 90s, too, but I can't speak to that) that are now having this type of surgery to correct those problems.

And the saddest part? I've also been told that there are some orthodontists out there that are still treating patients the way I was treated in the 80s. We didn't know better then, but we do know better now!
I know exactly what you mean. Although I didnt have any teeth pulled I had traditional braces to try to fix crooked buck teeth. Instead of widening my palate and moving my maxilla forward so my mandible could follow suit, my orthodontist just shifted all my teeth to the back of my throat. I now have narrow arches, no room for my tongue, a chronic stuffy nose, sleep apnea, and an underdeveloped jaw (mandible). My jaw started clicking around 18 or 19 and I went back to my old orthodontist just to ask for his opinion and he was so defensive and standoffish that I should have punched him in the face. All he kept saying was my teeth line up perfectly. There is way more to orthodontics than perfectly aligning teeth. Because of my narrow palate I now have less bone structure to hold up my skin and I look like I am aging rapidly along with all the other issues I mentioned. Its really discouraging and depressing. Another reason why I am so certain that the old school braces stunted my palatal growth is the fact that my 16 year old molars which came in after my braces came off are way wider than the rest of my dental arch.

SantaBarbarian
Posts: 15
Joined: Tue Apr 05, 2016 1:18 pm

Re: Is this right - Gunson/Arnett

#38 Post by SantaBarbarian »

On April 5, 2016, I posted the cost break-down for my surgery in December 2015 with Dr. Gunson as of the time of writing. I was still fighting my insurance company regarding the fees. It took nearly a full year to resolve the fight, but it did indeed end last year. And, I got them to pay virtually everything! Please see my earlier post in this thread from April 5, 2016 for more details on how I was able to do this, as it's a long story.

At least, I think the fight is over. More than a year after the surgery, I've received several letters in the mail supposedly from an outside third party trying to verify fees associated with the surgery. I've never received a phone call and it's not from Cigna. I don't trust it, so until Cigna contacts me, I'm disregarding the requests from this outside source for information and authorization to get the hospital to provide more info.

So, here's where we ended up:

-Orthodontics: $6,000, paid in full by me.

-Anesthesiologist: $7,500, eventually paid in full by insurance. Cigna did not follow their own policies at first (shocker!) and tried to low-ball the number. I had to tell the Cigna representatives how it's supposed to be processed. Eventually/several calls later, they agreed and paid the fee in full. (Incidentally, Dr. Funk would accept just $3,075 if you paid it in cash - something to keep in mind if you cannot get them to pay at the in-network rate; for me, Dr. Funk was covered at the in-network rate that was not subject to the maximum reimbursable cost because he's part of some third-party group AND the hospital is in-network for me).

-Operating Room and one-night hospital stay: charged $136,000. A lot of these fees were actually for the hardware that went into my mouth (screws, plates, etc - thousands of dollars each and there were a lot of them). Cigna allowed and paid $122,500. Since my in-network deductible was already met and GVCH is in-network, I didn't pay a dime and amazingly there was no fight over this.

-Dr. Gunson's surgical fees: $53,200. About $5,500 of this was for cheek augmentation. Pulling my jaw that far forward would have left my face looking sunken and just "wrong." But this is also considered "cosmetic" by insurance companies so trying to fight this is a waste of your time. The remainder (about $47,300) was ultimately covered in full by Cigna, but this was a huge, multi-month fight. At the time of my surgery, Dr. Gunson would submit all non-cosmetic fees to insurance in this manner:
--a small sum (about $500, I forget) for the pre-op appointment immediately before surgery. This was split roughly evenly between two procedure codes: one for a scan, one for a 45-minute appointment office appointment. Each code was subject to the MRC so Cigna did not want to pay this in full; I had to argue that Dr. Gunson actually provided far more services than he billed for that day. In reality, Dr. Gunson or his staff worked with me and/or my family for six hours that day, plus a follow-on visit the following day. He also took pictures, molds, etc., some of which he did not bill for in his line-item.
--Approximately $46,200 for the surgery itself. This was split among four line items: 2 for Dr. Gunson, and 2 for the assistant surgeon. Nobody ever told me that the bill to Cigna would be split between Dr. Gunson and the Assistant surgeon, or that the Assistant Surgeon would also require pre-authorization to be considered in-network. I advise anyone trying to have surgery with Dr. G that wants to get the most back from their insurance to get them to cover him AND his assistant surgeon at the in-network rate before the surgery.
Each of these four procedure codes (two for Dr. G, 2 for the assistant surgeon) were initially subject to the MRC, and it was a fight to get them to go beyond the MRC, but they eventually did. More on that below.
--$340 for each of three post-op scans (one two-weeks after, one a few months after, and one two years after) for a total of $1,020. These fees are included in your up-front payment but Dr. Gunson's office does not bill your insurance for them until after you've had the scans. My two-week scan was initially subject to the MRC (about $250 at the time) but ultimately paid in full with everything else. My scan a few months afterward was allowed in full but occurred in the following calendar year so it applied entirely to my deductible. I had relatively few expenses in 2016 so I never got that cash back, nothing I can do about that and fighting it is a waste of time. Since I'm still less than two years post-op, I haven't had the third and final scan; I may or may not get some additional money of the final $340 back as it depends on my deductible situation when the bill is submitted.
***In the end, and after multiple, long fights, Cigna paid me a little over $47,000 of the $53,200 surgical fee for Dr. Gunson.***

-There were also about $250 for post-op drug costs, some (but not all) of which was covered by insurance not included in any of the above.

******************************
Summing up all the above:
Approximately $183,500 for the surgery, anethesiologist, hospital, and drugs (plus $6,000 for orthodontics not included). Of that, I paid about $6,350 (plus all of the $6,000 cost for orthodontics).
******************************

-----------------------------
Critical means to get your insurance to pay as much as possible:
---Get the surgery authorized.
---Get in-network coverage for Dr. Gunson AND THE ASSISTANT SURGEON before the surgery.
---Get the insurance company to waive the Maximum Reimbursable Cost cap that applies to all out-of-network providers, even if they are covered at the in-network rate.

Each of the above is be tricky. I've posted in this thread and others tips for the first two items. Getting insurance companies to waive the MRC cap (item 3 above) required me to realize ahead of the surgery how Dr. Gunson bills for his services. Specifically, he bills the patient for everything up-front, including all pre-op, post-op, and surgery itself fees. This is a bottom-line, all-in number and the specific line-item cost doesn't really matter (with one exception: you're going to be stuck with whatever the aesthetic fees are). He then bills this to insurance as described above (the vast majority is billed as the surgery itself, and there are almost $0 in post-op fees and the pre-op fees are minimal compared to the amount of services he actually provides). This, unfortunately, is not how insurance companies pay for fees; they pay as services are provided. And if you are in the office for six hours and 15 minutes, your bill should show one unit for a 45-minute appointment plus 11 units of 30-minute follow-on services, and each of those units needs a fee associated with it.

Recognizing that Dr. Gunson's billing practices and insurance company's billing practices do not play nicely with each other, I asked BEFORE THE SURGERY for (1) Dr. Gunson to sign a form that indicated how many services he provided during pre-op and post-op care, and (2) Cigna to pay the MRC for each of these services even though there would not be a line-item fee associated with each of the services. Neither Dr. Gunson nor Cigna normally do this and it was hard to get both sides to agree to make this exception, but both sides did agree before the surgery.

After the surgery, Dr. Gunson signed the forms (I helped prepare them to minimize time for him and his office staff - this was an exception he made for me so I wanted to make it as easy on him as possible) and I submitted them to Cigna. Cigna then rejected the claims saying that there was no fee attached to each service provided. In other words, they went back on their original agreement. Major frustration! I worked with the head of my company's HR department. Our plan is self-funded (so my company actually pays the bills) and Cigna just administers the plan. MANY, if not most, employer-provided plans work this way, they just don't tell you. This can put you in the awkward situation of asking your employer to ask Cigna to authorize fees that end up costing your employer money. Fortunately, the head of my HR department agreed that Cigna should pay something for the tremendous amount of service that Dr. Gunson includes in his surgical fees (but does not provide a line-item fee). He said the question was how to determine what was fair. Ultimately, they decided that the only fair determination they could make was to waive the MRC cap (in essence, pay everything!).

When I got that news I was thrilled. Then I discovered that they hadn't allowed the same waiver for the assistant surgeon. Another fight ensued to get the same waiver for her, since it's a bottom-line fee to the patient and everything is included. Eventually they relented and paid "her" fees too (which, as far as I'm concerned, are all part of the same lump sum I paid to Dr. Gunson's office way ahead of surgery).

This was a lot of info to provide and I hope it it helpful to someone...!

Nochokin
Posts: 18
Joined: Tue Sep 04, 2018 8:55 pm

Re: Is this right - Gunson/Arnett

#39 Post by Nochokin »

Santabarbarian,
I’m curious to know how you are doing. I have a very similar history and surgery outcome to yours. As I am 9 months post op I am wondering what residual effects you have from the issues with your nerve. My nerve ruptured as well and there is very little info regarding the sensations as a result. I’d greatly appreciate any input on what to expect.

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