Hello,
Cigna Dental insurence only covers so many visits to the dentist under normal conditions. With the cancer and up coming radiation , my mom will be seeing her dentist more often. How do I get around this. Can her doctor refer the nessasary procedures to the dentist so the insurence will cover more? I have a horrible feeling that the dental side of all this is going to be more than we can afford.
Also should her primary doctor refer her to a dentist who specializes in cancer paitents. I am having a hell of a time finding one.

annabel

Annabel,

Do you have a medical TEAM or are you the coordinator of everything? In my case, there was an oral surgeon, an otolaryngologist, a radiation oncologist, a medical oncologist, a social worker and a nutritionist on my team. A tumor board reviewed the plan of attach and approved it before anything happened. I found out dental insurance pays to pull out my teeth but not to put anything back in, even though I know of others on a different BC/BS plan that paid for implants as a medical necessity. It is tough but it sounds like you are really getting a rough deal. Is there a social worker in the oncology department that can help guide you to the resources you need?

Ed

I had to fight to get my dental work done before radiation but I won the battle. My medical insurance company picked up the tab for some root canals I had done before I started radiation, it didn't even go through the dental insurance. Now granted, I had to FIGHT like crazy but it was worth it. My implants and other dental work is also being paid for by my medical insurance. Place one call each and every day, make sure they know who you are.

Annabel:
Medical necessity... A key term... Most Major medical insurance companies will pay for your dental work because they are forced to do so.. Like Minniea says, you have to fight like crazy . But you are fighting to keep your head above water financially as well as survive cancer...

You can't get around all of it! I have been with my same dentist for so long that he is absorbing the cost of the third cleaning (they will only pay for 2 a year -period). They wouldn't pay for the dental trays either. I told my dentist that I would have the doctor to write a letter that they were a "medical necessity" and that may have worked, but it fell through the cracks. They will only pay for x-rays once a year also. I had a baseline set taken and then I had a repeat set taken when I was finished with treatment because my teeth were so beat up from xerostomia, etc. I had to pay for that. I can only imagine the nightmares of getting them to pay for implants.

Very insightfull information. No I don't really have a team. There was one for the surgery and reconstruction but thats all. There is a case worker at Loma Linda but I thought she only worked with HMO insurence. I thought her Cigna Dental insurence was seperate from Blue Cross, I will be checking that one out asap. Dental issues were the last thing mentioned and only casually as in "Oh, bye the way she should she a dentist before radiation....you make the appt." Anyways thanks for the guidence...Annabel

I belong to an HMO (Kaiser Permanente) and they paid all of the expenses from UCSF including the dental oncologist consult and panorex x-rays. They also paid for a CT at UCSF and 100% of my followup visits until UCSF determines I don't need to be seen by them. The bill the HMO paid for my IMRT alone was over $300,000.00. There wasn't even a copay for ANY of it. My medical covered the dental oncology exam because it was a medical necessity. The radiation oncologist would not start therapy until the dental consult, they also insisted on an MRI, a PET scan and a Hep C test. The HMO moved me to the "head of the class" and I received the scans and tests in a matter of days. I also had a nutritionist at UCSF as well as one at Kaiser.

I determined later on that they weren't going to touch my teeth. The 10% chance of ORN wasn't worth it, not to mention that some of that percentage get ORN WITH their teeth pulled. They started out wanting to pull all of them, then changed it to just the ones in the radiation field. I am glad I kept my teeth. It takes a lot of discipline to stay on top of the maintenance required though. I use a WaterPik after every meal or snack, floss at least once a day, dental trays with flouride several times a week, 3 cleanings a year, etc.

My dentists son, who recently graduated from UCLA school of dentistry, has received some training as a standard part of his curriculum in treatment of cancer patients. He had some really great up to date materials and that helped also to make the decision to keep the teeth.

Maybe the dental oncologist at LLUMC can give you a referal.

Gary,
Could he give me a referral in NJ. I have also have tongue ca, resection, nodes removed that were positive and radiation. I'm a 7 year survivor but now my gums are breaking down. I have had 8 caps w/ root canals so far. I'm wondering about pulling them (I'm 40 years old and this terrifys me)
I'd appreciate any advice you can give. Thanks Maria

You can't just have your teeth pulled. We have a lifetime risk of ORN. You will have to get HBO first. I would be seeing a periodontist if you have gum disease.

Gary,
Yes, I realize that I shouldnt pull them, but I am so frustrated between fighting with the insurance and the constant care that I sometimes wonder if thats going to be the end result. I am going to a dental oncologist next week for a consult, so I'll see what he has to suggest.Maria