| | Joined: Dec 2011 Posts: 9 Member | OP  Member
Joined: Dec 2011 Posts: 9 | Hi all. I'm new to this site and really need help! My husband's story is loooooooong, as I'm sure are many others. I'll try to keep this as short as possible.
2 yrs ago my husband was diagnosed and treated for scaumous cell carcinoma of the left lateral tongue. (T1N2M0) He had every complication imaginable and even ones that were new for his docs.
Now, 2 yrs out, he has developed serious tooth decay and has been told they all need to come out. So, he just finished 20 hrs of hyperbaric dives in preparation for the tooth removal. The health insurance paid for that treatment, but now refuses to pay for the tooth removal! He is in pretty bad pain and is totally deflated now.
Anyone have any advise for us? Thank you in adavance for reading. | | | | | Joined: Jun 2007 Posts: 10,507 Likes: 7 Administrator, Director of Patient Support Services Patient Advocate (old timer, 2000 posts) | | Administrator, Director of Patient Support Services Patient Advocate (old timer, 2000 posts)
Joined: Jun 2007 Posts: 10,507 Likes: 7 | If this is an after effect from radiation then your medical insurance should pay for it. I have gone thru it too and mine was covered, but my surgery was also done in the hospital due to my trismus. You may need to appeal and have the oral surgeon also write to the insurance company. Im very surprised they would pay for HBO without giving the go ahead for doing the tooth removal. Of course insurance companies are out there to make money so many of them commonly say 'NO' when they should be approving something. One thing that may help is to check into the medical coding on the procedures, this alone could make or break the claim.
Please add a signature when you have time. It will greatly help us to get to know you and your husband. Click on the "My Stuff" tab, then on the drop down menu, "Profile". Scroll to the bottom and type in the white box, click "Submit" and you are all set.
ChristineSCC 6/15/07 L chk & by L molar both Stag I, age44 2x cispltn-35 IMRT end 9/27/07 -65 lbs in 2 mo, no caregvr Clear PET 1/08 4/4/08 recur L chk Stag I surg 4/16/08 clr marg 215 HBO dives 3/09 teeth out, trismus 7/2/09 recur, Stg IV 8/24/09 trach, ND, mandiblctmy 3wks medicly inducd coma 2 mo xtended hospital stay, ICU & burn unit PICC line IV antibx 8 mo 10/4/10, 2/14/11 reconst surg OC 3x in 3 years very happy to be alive  | | | | | Joined: Dec 2010 Posts: 5,260 Likes: 3 "OCF Canuck" Patient Advocate (old timer, 2000 posts) | | "OCF Canuck" Patient Advocate (old timer, 2000 posts)
Joined: Dec 2010 Posts: 5,260 Likes: 3 | Hi - welcome - I wish I could offer some advice - for now it will just have to be good luck! Take care.
Cheryl : Irritation - 2004 BX: 6/2008 : Inflam. BX: 12/10, DX: 12/10 : SCC - LS tongue well dif. T2N1M0. 2/11 hemigloss + recon. : PND - 40 nodes - 39 clear. 3/11 - 5/11 IMRT 33 + cis x2, PEG 3/28/11 - 5/19/11 3 head, 2 chest scans - clear(fingers crossed) HPV-, No smoke, drink, or drugs, Vegan
| | | | | Joined: Dec 2011 Posts: 9 Member | | OP Member
Joined: Dec 2011 Posts: 9 | Thank you Christine and Cheryl for your comments. This is so frustrating, since the insurance co. paid for the oxygen treatment.
10/2009 husband diagnosed SCC(tongue): Stage IV (T1N2M0)
IMRT: 35 doses & Chemo: 6
Multiple complications/hospitalizations.
Stricture of esophogus, 2 procedures to stretch
10 mos w/o food, lost 55lbs.
01/2011: ONJ
| | | | | Joined: Jul 2011 Posts: 945 "Above & Beyond" Member (500+ posts) | | "Above & Beyond" Member (500+ posts)
Joined: Jul 2011 Posts: 945 | If Scrooge lived today I am sure he would work for the insurance industry.
You could also try talking with the HR person at your/his company that deals with insurance - they may have some experience with this.
CG to husband - SCC Tonsil T1N2M0 HPV+ Never Smoker
First symptoms 7/2010, DX 12/2010
TX 40 IRMT (1.8 gy) + 10 Cetuximab
PET Scans 6/2011 + 3/2012 clear, 5 year physical exam clear; chest CT's clear of cancer. On thyroid pills. Life is good.
| | | | | Joined: Nov 2002 Posts: 3,552 Patient Advocate (old timer, 2000 posts) | | Patient Advocate (old timer, 2000 posts)
Joined: Nov 2002 Posts: 3,552 | The insurance might pay for it if it is done under general anesthesia, in a hospital, by a dental oncologist. That's what they told me anyway at UCSF.
The medical insurers won't pay for any dental work, extractions or otherwise unless you have dental insurance, which in general sucks.
Considering all of the scientific evidence of dental health being key to health, in general, it is incomprehensible why these greedy bastards won't pay for it. Especially since this was caused by a clearly medical condition.
Gary Allsebrook
***********************************
Dx 11/22/02, SCC, 6 x 3 cm Polypoid tumor, rt tonsil, Stage III/IVA, T3N0M0 G1/2
Tx 1/28/03 - 3/19/03, Cisplatin ct x2, IMRT, bilateral, with boost, x35(69.96Gy)
________________________________________________________
"You are a mist that appears for a little while and then vanishes" (James 4:14 NIV)
| | | | | Joined: Jan 2011 Posts: 571 "Above & Beyond" Member (500+ posts) | | "Above & Beyond" Member (500+ posts)
Joined: Jan 2011 Posts: 571 | Ugh! We had our battles re: oral surgery.
We went to USC School of Dentistry to have four teeth extracted in preparation for radiation. The head of the Department of Oral Surgery performed the extractions. And, the cost was about half of what the oral surgeon (who was recommended by the OD) was going to charge.
University dental schools are often excellent places to get high quality dental care at a lower cost.
Since preparation and having appropriate (primary) closure was imperative, she would only trust a few oral surgeons. The oncology dentist was happy J was having oral surgery at USC and she was pleased with the results.
Our dental insurance did pay for part of the expense.
Btw, it is a good idea to get a second opinion and estimate of charges if at all possible. As with all specialties, some dentists are more experienced and understand what is appropriate and what is likely over-treating a problem. Less experienced professionals will often err on the side of doing too much.
In our situation, we found out that the oral surgeon to whom J was referred by his OD was going to charge for extracting impacted wisdom teeth. The teeth were not impacted. This oral surgeon was padding his bill by about $1000. When we got the second opinion from USC, I noticed that the billing codes were different and the charges were much lower compared to the prices quoted over the phone by the rep from USC (I gave the rep the billing codes from the first oral surgeon so she could give me a rough estimate.) Billing codes are universal in the industry. It's disgusting that an oral surgeon would cheat his patients...and even worse, that he would cheat cancer patients. I hope there's a special place in hell for him and people like him.
Last edited by Sandy177; 12-21-2011 05:57 PM.
Ex-spouse MISDIAGNOSED with SCC-HN IVa 12/10. Tonsils out 1/11. 4 teeth out 2/11. TX Erbitux x2, IMRT x2 2/11. 2nd opinion-benign BCC-NOT CANCER 3/11. TX stopped 3/11. New doctors 4/11. ENT agrees with 2nd opinion 5/11. ENT scoped him-all clear 7/11. Ordered MRI anyway. MRI 8/22/11 Result-all clear.
| | | | | Joined: Feb 2012 Posts: 38 Contributing Member (25+ posts) | | Contributing Member (25+ posts)
Joined: Feb 2012 Posts: 38 | amazing!
in Seattle, HBO2 dives are $1400+/per dive, amazing insurance would be willing to pay for this, yet not pay for a relatively cheap removal of teeth.
69yo male, Steam Engineer, Me=4,SCC=0, loving wife, living life as it comes (no other option)
We are all born from Mother, but live and die alone.
Make the best of it, Mommie did all she could, daddy was just a guidance councelor, the rest is ALL up to you.
...and now, 3rd occurance: Surgery 5/1/12
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