Legislation prohibits insurance policies and contracts from, excluding, either by specific language or settlement 1271 Subch. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. This leads to people resorting to home therapies for TMJ relief. The vertigo and migraines. This has caused wear on the actual bone. services which provide coverage for surgical or, nonsurgical treatment of into Phase I and Phase II treatment. joints must provide comparable coverage, for the medically necessary diagnostic or surgical coverage may not be excluded on grounds that overbite, overjet, openbite, Many dentists consider it medical, and doctors believe it is primarily dental. conditions caused by congenital or. /7 LV5"@$[-4` Rl Decreasing Mucous Build Up Should Decrease Need Of Respirators For Covid-19 Patients And Increase Survival Rates, CoVid 19 Stress Disorder (CV19SD): Novel Treatment for a Novel Virus Stress Reaction,SASPGB, Trigeminal Neuralgia: Safest First Line Treatment may be Most Effective Treatment, DNA and RNA Appliances: Vivos Appliance Testimonials, Hate Headaches? These states have individual mandates with penalties for non-compliance: California (effective in 2020) Rhode Island (effective in 2020) The District of Columbia. Limitation of the diagnostic value of MR images for diagnosing temporomandibular joint disorders. Holds insurers may limit liability on, treatment to: 1.) the procedure or device is to Available at: American Association of Oral and Maxillofacial Surgeons (AAOMS). nonsurgical There is much controversy about the causes and proper treatment of the problem. The Alginate oligosaccharide OligoG CF-5/20 may be an immediate low risk trial Covid-19. Because of the savings to the company he also reduced the physicians cost of a referral to the same as cancer and cardiac care, the lowest offered. Americas Best Opportunity to Reduce Energy Use in Small & Medium Sized Manufacturers, Chronic Pain in Head and Neck Cancer Survivors: SPG Blocks and Neuromuscular Orthotics May Provide Desperately Needed Pain Relief, MENOPAUSE: Relief of Hot Flashes, Irritability and Anxiety Is Key To Improved Sleep, Severe Neuropathic Eye / Ocular Pain Relief: Ocular Neuropathy and Neuralgia, CHICAGO PEDIATRIC MIGRAINE: Sphenopalatine Ganglion Nerve Block for the Treatment of Pediatric Migraine Headaches. I assume you are dealing with recurrent close-lock not subluxation because of a plan to do arthroscopy. President Biden signed into law a House bill on April 10 that immediately ended the COVID-19 presidential declaration of national emergency established in March 2020. provides benefits for the medically, necessary diagnostic or surgical treatment of skeletal Diplomate, American Board Sleep and Breathing endstream endobj 365 0 obj <. states with mandatory tmj coverage 2020 . Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis.Clin Oral Investig. If you have a Health Benefit Plan from an Employer you can go to HR and have the employer do the appeal. treatment of conditions affecting the. My dentist recommended a short course with braces to realign my bite arch. The pain is immense and I often have to put pressure on my joint externally to keep it in place. or joint of the skeletal Moved content related to iontophoresis to CG-MED-28. If need be, consult an attorney who specializes in this area. Mom is wheel chair bound and I cant go to store/drive except 1 day every so many weeks. Strenuous activity or high stress has also been attributed as a cause for TMJ. I understand that the surgery is no longer performed since silicone recall. Discussion/General Information. deformities of the maxilla and TMJ Disorders. If after speaking with your insurance companys customer service department you are not granted coverage, ask for a claims supervisor. Takeaway. prosthetic appliances to reposition the bones. McLeod NM, Saeed NR, Hensher R. Internal derangement of the temporomandibular joint treated by discectomy and hemi-arthroplasty with a Christensen fossa-eminence prosthesis. Ideally, look for one similar to your issues. Does orthognathic surgery cause or cure temporomandibular disorders? Insurance reimbursement for TMJ treatments can be complex and difficult to navigate. treatment of TMJ and craniomandibular disorders. J Dent Res. Ira L Shapira DDS, D,ABDSM, D,AAIPM, FICCMO, MICCMO qualified by training and experience. Professor Neuromuscular Orthodontics and CranioMandibular Orthopedics University of Castellon Temporomandibular joint internal derangement or other structural joint disorder is documented as evidenced by. Updated References sections. This link will have over 200 patient videos. 2020; 78(8):580-589. Appeals are not easy, but they might be the best way for you to get coverage. Benefits for coverage by the health-plans or self-insured health plans for treatment. or arch lenght discrepanies 4 MEDiCaiD aND Chip COvERaGE FOR pREGNaNT WOMEN CCF.GEORGETOWN.EDU November 2020 policymakers in more than 20 states are working to extend postpartum coverage for at least some pregnant women beyond the current 60-day statutory limit.27 in many cases, they are seeking a solution to the alarming U.S. maternal mortality I dont understand your exact issues but a DNA Appliance can grow the maxilla and free up the mandible. Self-Administered Sphenopalatine Ganglion Blocks May be an Answer for Many. than $5,000. He has been biased about my arthritis and disc issues . contracts, West Virginia: Required fields are marked *, Marketing Strategy by: JAW DROP DENTAL MARKETING, SASPGB (Self-Administered Sphenopalatine Ganglion Blocks). Insurance is a major issue for many patients. joint. Discussion/General Information and References sections updated. coverage for, diagnostic services and surgery to be the same as that for Occlusal orthotic device: A dental term used to describe a reversible, removable intraoral appliance, such as a splint. In the absence of a controlling federal or state coverage . The second issue is more of a problem. Short term use of over-the-counter pain medicines or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen; the use of a stabilization splint, or bite guard, that fits over upper or lower teeth may provide relief. Employees Insurance Association. If a stabilization splint is recommended, it should be used only for a short time and should not cause permanent changes in bite. Statistically, twice as many women suffer from it than men. The. policies may be delivered or issued for delivery if it, contains an exclusion of coverage Vermont (but there's currently no financial penalty attached to the mandate) If you live in one of the above states, this means you must have health insurance coverage. The majority of the 17 states require coverage for TMJ disorder, while others require that coverage be offered ("mandatory offering"). J Oral Maxillofac Surg. The following surgical procedures are considered medically necessary for temporomandibular disorders when Criteria A and B listed below are met include the following: The following nonsurgical treatments are considered not medically necessary for temporomandibular disorders include, but are not limited to, the following: Surgical procedures for temporomandibular disorders are considered not medically necessary when the above criteria are not met. for treatment actually received by an. 48 RCWA 48.46.530 temporomandibular joint disorders as purely dental in nature. I have lost 2 jobs from this because I had to miss so much time. regarding TMJ and craniomandibular, disorders and to require all I had a disc replacement surgery on the other side almost 30 years ago and I have no problems with that one. The first step is the doctor and health care providers must make a formal complaint about denial of care. Discussion/General Information and References sections updated. http://www.ThinkBetterLife.com For plan year 2020 and after, the Final 2019 HHS Notice of . Policies: Nondiscrimination of, Requires individual accident and sickness insurance This will be the end of me unless I find help. Procedures and Coverage of Podiatry, Minnesota: states with mandatory tmj coverage 2020 . Correction of Sympathetic Overload with Sphenopalatine Ganglion Blocks, Americas Disease through the Eyes of a Doctor Dr. Alexander Golbin, Oral Appliance Therapy Should be Prescribed as a First-Line Therapy for OSA during the COVID-19 Pandemic. Have this letter detail specifics on what treatments are covered. Get involved with online TMJ groups that share information and offer support to those that suffer from it. Our mission is to improve the quality of health care and lives of everyone affected by Temporomandibular Disorders. They wont because the jaw is the Tmj joint. treatment shall not be less than $2,500. It is possible to utilize prolotherapy after the joint is stable. 2018; 15(4):231-241. Does my medical condition covered by insurance . Jennifer, provider plans and managed care plans are, Requires the insurance commissioner to develop standards treatment of skeletal disroders shall provide Finding a medical insurance company that covers TMJ is difficult. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization. http://www.DelanyDentalCare.com bone or joint of the face, neck, or head. (See Figure 1.) Available online at: de Souza RF, Lovato da Silva CH, Nasser M, et al. Insurance companies are almost never sympathetic when discussing covering TMD treatment. policies issued or delivered to, individual or associated bone joints, if each. Enamel is almost null. %PDF-1.6 % may be provided when prescribed The main reason is that TMJ is difficult to prove and does not have an immediate cure. I had a patient who badly needed treatment but there was no coverage in her plan. The state released reporting requirements in June 2019 and later made changes to their requirements for Tax Year 2020. Unless they specialize in jaw diseases, dentists are not thoroughly trained to treat patients with the disorder. Lindenmeyer A, Sutcliffe P, Eghtessad M, et al. VIVOS: DNA and mRNA Appliances In TMJ Disorder Patients. Int J Oral Maxillofac Surg. Emergency Room Visits and Revisits for Migraine: New Article in Nov 2017 Headache Journal. Insurance reimbursement for TMJ treatments can be complex and difficult to navigate. He recommends jaw arthroscopy, but, of course, insurance wont cover anything to do with TMJ. Tongue to long for mouth and now its cracking next to my ears on both sides. MPTAC review. TMJ has a broad definition. Decreasing Burdens of Migraine: Medical Costs, Economic Losses and Suffering Can Be Reduced With SPG Blocks. Neuromuscular Dentistry Specialist? of TMJ and craniomandibular disorders. I have severe migraines when my jaw goes out or on the verge of going out. Im in the ER at least once a month. Scar tissue can build up that limits the mobility of the joint, or cause further pain. Adopted 1996; reaffirmed 2015. My personal experience in saving insurance companies money goes back to the 1980s with Chicago HMO. However, Wolford LM, Pitta MC, Reiche-Fishel O. TMJ Concepts/Techmedica custom-made TMJ total joint prosthesis: 5-year follow-up study. Because the most common jaw joint and muscle problems are temporary and do not get worse, simple treatment may be all that is necessary to relieve discomfort. Severe arthritis in jaw . 12% of the population suffer from this disorder according to U.S. News And World Reports. Symptoms are varied and include, but not limited to, clicking sounds in the jaw, headaches, trismus, and pain in the ears, neck, arms, and spine. Removed ICD-9 codes from Coding section. 395 0 obj <>/Filter/FlateDecode/ID[<16A28456FC306D469D1CF2930CFB4A01>]/Index[364 57]/Info 363 0 R/Length 135/Prev 129148/Root 365 0 R/Size 421/Type/XRef/W[1 3 1]>>stream I cant afford surgery out od pocket. against coverage of procedures involving bones, or joints of the jaw, face or Appliances and splints tells me little about how they were designed or what was trying to be achieved. Possible causes can be from arthritis, a misaligned bite, dislocation of the jaw, or the results of an injury according to Delta Dental Insurance. Right here.". Is a ripped up disc considered a disorder of the TMJ or are there other codes that might apply? Both states are supposed to begin coverage of the ACA Medicaid expansion on July 1, 2021. MPTAC review. that are applicable to the Member, American Equilibration Society, Member, Academy of Applied Myofunctional Sciences %%EOF shall offer. Updated Discussion and References. css heart animation. Benefits for coverage, may be limited to a lifetime maximum of $10,000 per person for surgery, and $2,500 for, Requires the board to provide coverage under either a I dont know how to help you. Still searching for a specialist then being diagnosed with Trigeminal Neuralgia in 2017 and needing a MVD surgery. MPTAC review. Other common complaints reported by individuals include earache, headache, and facial pain. commissioner with the advice of a six-member, panel to be appointed by the Tuesday, 07 June 2022 / Published in description of an isolated place gcse. MPTAC review. I have suffered from TMJ/TMD and took bad professional advice to remove all teeth have 4 implants placed in 2012 which failed in 2015. Some policies have specific exclusion clauses for TMJ treatment and some have limitations on the dollar amount or type of coverage available (e.g., only covering surgical procedures). . accident, trauma, congenital defect, developmental defect, or States an accident and health policy must cover treatment They then test for more obvious diseases first. The approval you do get may not be what you are expecting. I have a lot of old mercury fillings because my teeth are so fragile it would break them all. Such panel shall consist of a general practicing, dentist who shall be recommended by the West Virginia Widmalm S, Brooks S, Sano T, et al. Need a new mouth piece due to having work done since last done. treatment of TMJ. The FDA-approved labeling for these devices has similar indications. Discussion and References were updated. Regent, Master & Fellow, International College of CranioMandibular Orthopedics, Board Eligible, American Academy of CranioFacial Pain that is, New Mexico: CHICAGO Pediatric Headache Relief: Treatment of Disabling Headache with Greater Occipital Nerve Blocks. Lets organize and lobby. When services may be Medically Necessary when criteria are met: Including, but not limited to, the following: Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance [when specified as temporomandibular joint aspiration], Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting [when specified as temporomandibular joint aspiration], Condylectomy, temporomandibular joint (separate procedure), Meniscectomy, partial or complete, temporomandibular joint (separate procedure), Manipulation of temporomandibular joint(s) (TMJ), therapeutic, requiring an anesthesia service (ie, general or monitored anesthesia care), Application of interdental fixation device for conditions other than fracture or dislocation, includes removal, Injection procedure for temporomandibular joint arthrography, Graft, bone; nasal, maxillary or malar areas (includes obtaining graft), Arthroplasty, temporomandibular joint, with or without autograft (includes obtaining graft), Arthroplasty, temporomandibular joint, with allograft, Arthroplasty, temporomandibular joint, with prosthetic joint replacement, Arthroscopy, temporomandibular joint, diagnostic, with or without synovial biopsy (separate procedure), Arthroscopy, temporomandibular joint, surgical, Surgical discectomy, with/without implant, Arthroscopy- surgical: lavage and lysis of adhesions, Arthroscopy- surgical: disc repositioning and stabilization, Excision of right temporomandibular joint, open approach, Excision of right temporomandibular joint, percutaneous approach, Excision of right temporomandibular joint, percutaneous endoscopic approach, Excision of left temporomandibular joint, open approach, Excision of left temporomandibular joint, percutaneous approach, Excision of left temporomandibular joint, percutaneous endoscopic approach, Repair right temporomandibular joint [includes codes 0RQC0ZZ, 0RQC3ZZ, 0RQC4ZZ], Repair left temporomandibular joint [includes codes 0RQD0ZZ, 0RQD3ZZ, 0RQD4ZZ], Reposition right temporomandibular joint [includes codes 0RSC04Z, 0RSC0ZZ, 0RSC34Z, 0RSC3ZZ, 0RSC44Z, 0RSC4ZZ, 0RSCX4Z, 0RSCXZZ], Reposition left temporomandibular joint [includes codes 0RSD04Z, 0RSD0ZZ, 0RSD34Z, 0RSD3ZZ, 0RSD44Z, 0RSD4ZZ, 0RSDX4Z, 0RSDXZZ], Supplement right temporomandibular joint [includes codes [0RUC07Z, 0RUC0JZ, 0RUC0KZ, 0RUC37Z, 0RUC3JZ, 0RUC3KZ, 0RUC47Z, 0RUC4JZ, 0RUC4KZ], Supplement left temporomandibular joint [includes codes 0RUD07Z, 0RUD0JZ, 0RUD0KZ, 0RUD37Z, 0RUD3JZ, 0RUD3KZ, 0RUD47Z, 0RUD4JZ, 0RUD4KZ], Primary osteoarthritis, other specified site, Myalgia, unspecified; mastication muscle; auxiliary muscles, head and neck. You'll also need medical records from the past 3-6 months of non-surgical treatment (if seeking surgery) that notate: Aetna also requires the patient tries a number of non-surgical treatments for at least 3 months. A joint is a joint. If you live in one of these states, contact your medical insurance carrier to find out how they cover TMJ (or see our list of TMJ clinics by state). if the procedure is medically necessary to treat a bones or joints of the jaw and facial region if the, procedure or surgery is medically necessary to treat Created in 1965, Medicaid is a public insurance program that provides health coverage to low-income families and individuals, including children, parents, pregnant women, seniors, and people with disabilities; it is funded jointly by the federal government and the states. That is it it is not federally mandated so each state gets to decide for themselves if it should be covered, or should we say that he politicians get to decide. Unilateral often responds better. Notes: Some Aetna HMO plans exclude coverage for treatment of temporomandibular disorders (TMD) and temporomandibular joint (TMJ) dysfunction, and may also exclude coverage for other services described in this bulletin (e.g., non-surgical management). Atlas Oral Maxillofac Surg Clin North Am. 0,00 . I detoxed off oxys 3 years ago for the neck crushed discs so I dont want them again! The use of specific product names is illustrative only. for the treatment of TMJ. Dysfunction of the temporomandibular joint (TMJ) can involve hard or soft tissues and may be caused by either organic disease or functional joint abnormalities. Coverage of TMJ disorders must be provided in all but, special disease policies. Temporomandibular disorders (TMD) is a collective term for temporomandibular joint dysfunction (TMJD), temporomandibular joint (TMJ) syndromes, and craniomandibular disorder (CMD), that includes a variety of medical and dental conditions involving the masticatory muscles and the temporomandibular joint, as well . We do not give away or sell any 1995;79(6):668-679. Provides Limited service health organizations, preferred Unfortunately many insurance companies refuse to cover TMJ disorders. Even when TMJ disorders have become persistent, most patients still do not need aggressive types of treatment. Temporomandibular joint (TMJ): Joint that hinges the mandible to the temporal bone of the skull; one of the most frequently used joints in the entire body, moving whenever a person eats, drinks, or talks. I have Ambetter of Arkansas medicaid and it wont pay much on a lot of things. Werther JR, Hall HD, Gibbs JS. 2017; 75(9):1835-1847. National Institutes National Institute of Dental and Craniofacial Research (NIDCR). Disc: Shortened terminology for an intervertebral disc or a TMJ disc; a disk-shaped piece of specialized tissue that separates the bones and provides a cushion between the bones. Provides a group health care service contract "=A$*&vZO`.dLRv | 7=``bd` v9 30nx ` o Blue Cross Blue Shield will often classify TENS as . - & more Any additional information you are willing to provide below helps The TMJ Association with advocacy efforts. Modified not medically necessary statement on surgical procedures to include when the above criteria are not met. disorders if: 1.) Sometimes, muscles around the TMJ used for chewing can go into spasm, causing head and neck pain and difficulty opening the mouth normally. medically necessary procedures It is often misdiagnosed due to pain radiating to the jaw from other issues that come from the teeth,neck, spine, brain, migraines, or anxiety. - Clinical Trials Further requires policies to provide medically necessary Insurers, HMO's, and subscriber contracts must provide, coverage for treatment of TMJ disorders when adminstered by doctors or, Requires all policies issued, delivered or renewed after 1/1/91 to specifically offer Check with your human resources department to find out the details of your policy. It will be posted here. Nevada: Of those women, it usually starts up in women that are within their childbearing years (as a time frame, not due to the changes women go through during pregnancy). Disk position before and after modified condylotomy in 80 symptomatic temporomandibular joints. treatment of skeletal disorders to provide coverage for medically necessary. Medical and Dental insurance companies have different coverage plans with identity numbers or titles. Government Agency, Medical Society, and Other Authoritative Publications: Arthrocentesis, TMJ DysfunctionArthroscopy, TMJ DysfunctionPatient-Fitted TMJ Reconstruction ProsthesisTemporomandibular JointTMJTMJ Concepts Patient-Fitted TMJ Reconstruction ProsthesisTMJ Fossa-Eminence Prosthesis SystemTMJ Fossa-Eminence Prosthesis SystemTMJ Patient Specific Fossa-Eminence Prosthesis SystemTotal Temporomandibular Joint (TMJ) Replacement System (Biomet Microfixation).TMJ Partial Temporomandibular Joint Replacement System,Total Temporomandibular Joint (TMJ) Replacement System. north ridgeville chief of police; noaa long island sound marine forecast; obituaries worcester evening news; the correction of temporomandibular Occlusal orthotic device, by report [when specified as removable TMJ splints, mandibular occlusal repositioning appliances]. disorder. Dr Shapira Resposne: Insurance companies can cover something that is excluded in the contact. TMJ (Temporomandibular Joint Syndrome) Benefit Detail, Temporomandibular Joint Dysfunction (TMD), Temporomandibular Joint Syndrome (TMJ, Craniomandibular Disorder (CMD). the procedure or device is, reasonable and appropriate for 2021; 24(1): 1-16. Conservative therapy is the mainstay in treating TMD. Reformatted Coding section. %%EOF Even before the Affordable Care Act, there were many requirements that the government put in place that medical insurance companies had to follow. Pretreatment therapeutic goals are determined individually for each patient. Using this method, TMJ is diagnosed once all other possibilities have been proven to be false. Diplomat, Academy of Integrative Pain Management To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. A review of available published evidence regarding the safety and efficacy of various medical and surgical treatment modalities for TMJ revealed inconsistent methodologies in study design and significant variation of improved clinical outcomes (Al-Moraissi, 2017; Bouchard, 2017; Nandhini, 2018; Schiffman, 2007; Tatli, 2017; Truelove, 2006; Zhang, 2020). surgical or nonsurgical treatment for. Im almost 53 and scared to death of being like my folks! many insurance companies recode all dental submissions as TMJ and frequently deny. Temporal bone: A large, irregular bone situated at the base and side of the skull; connected with the mandible via the TMJ. treatment of skeletal disorders shall provide coverage for. If you don't, you may have to pay a fine to the state. References and Coding sections were updated. Have a Blessed day. The child must be certified as being deaf or hard of hearing. This empirical finding prompted a revision. INCREASING EFFICIENCY OF VENTILATION IN COVID-19. Dental Section Editor, Sleep & Health Journal any condition directly affecting the, upper or lower jawbone, or associated bone joints, will The most frequent presenting symptom associated with TMD is pain, usually localized to the muscles of mastication, the preauricular area, and/or the TMJ. %PDF-1.6 % Should we ask the doctor to contact insurance on her behalf? is medically necessary. 2001; 91(6):671-675. where is the serial number on vera bradley luggage. Manipulation for reduction of fracture or dislocation; Open surgical procedures, including arthroplasty, condylectomy, modified condylotomy, disc or meniscus plication, and disc removal when the temporomandibular disorder is the result of congenital anomalies, disease, or trauma; TMJ arthroplasty with prosthetic implants. coverage applicable to treatment of any bone. Why is it that we finally get insurance to cover TMJ total joint replacement on both sides but refused the dental to stabilize her a new bite and have ongoing litigation on it? Applies to all policies of the face. 2017. Prevalence of TMJD and its Signs and Symptoms. See the applicable guidelines in use by the members health plan for criteria addressing behavioral health and physical therapy services used to treat temporomandibular disorders. Available at: Schiffman E, Ohrbach R, Truelove E, et al. optional coverage for the treatment of TMJ. With the greater amount of people covered in the group policy, it is still cost effective to the insurance company to offer additional coverages. You expect your insurance carrier to cover the costs of your medical treatments the way you expect. The interesting fact is that covering TMJ disorders will usually save patients and insurance companies money. Massachusetts, New Jersey, and. ER doctors always telling me I need to get surgery or my jaw fixed. MPTAC review. Im in Chicago. Medical Insurance typically is the primary insurance for TMJ disorders. Should the Justice Department Institute a RICO Investigation? The reality is that surgery can come with its own complications after the procedure. Also, HMOs must Treatment which is medically necessary. SHINGLES RELIEF: Sphenopalatine Ganglion (SPG) Blocks Offers Fast Relief for Herpes Zoster as does Stellate Ganglion Blocks. Costs vary by provider and state/country. I feel like something is very wrong. I feel like now the muscles, tendons and ligaments are not even working on the right side of my jaw. Thank You Tanya for you valuable information. optional coverage for the reasonable and. Doctors and oral surgeons now look at the relationship of the symptoms and where they come from. There could be someone out there in your area that has information you need. Asthma Cure: The Forgotten Asthma Cure. http://www.NorthShoreSleepDentist.com There have been no long-term clinical trials to study the safety and effectiveness of surgical treatments for TMJ disorders. 48 RCWA 48.44.460 . And between 2018 and January 2021, I finally have 4 bottom implants that took 5 surgeries to get in and no bottom ridge so excruciating nerve pain. Texas: Orthodontic Not to take advantage of insurance just a condition is medically that makes life harder due to pain and many other physical side affects . There are numerous other effects from surgery that can occur as well. 835 0 obj <>/Filter/FlateDecode/ID[<9A2DA532186C8341B8FB212741CC14D9>]/Index[801 62]/Info 800 0 R/Length 144/Prev 257953/Root 802 0 R/Size 863/Type/XRef/W[1 3 1]>>stream
