I am curious. My husband had a tooth extracted and had to have a bone graph because the hole was too large. My dental insurance refused to cover the bone graft. Said only covered if he is having dental implants and my dental plan does not cover implants. Well that was news to me. I emailed Jerry and his office says medical usually does not cover and very few dental plans have coverage.

SO, have any of you that got implants had it covered? If so, was it dental or medical? Did any of you get Medicare to cover it? Is this one of those deals where you need a letter of medical necessity to get it covered. I thought I was covered but it appears not.

Take care,
Eileen

Eileen,
That's a kick in the teeth. (pardon the pun.)
You may want to explore this avenue. In Canada, I'm not sure if the U.S. or for that matter individual States are the same, dental and medical insurers have what is called an, "Alternate Benefits Clause". What this means that if a specific procedure is not covered that they will provide benefit if a lesser procedure could have been performed. Example: An Implant is needed to replace a missing tooth. The patient's plan does not cover implants but would cover a fixed bridge which is a less costly procedure. The insurance provider in this example would provide coverage for the implant but, only up to the dollar amount that they would have paid if a fixed bridge (less expensive treatment) was being done. I'm not sure if this applies but it would be worth investigating.
Talk to the office that provided the service to see if they can help you.
Cheers,
Mike

Many dental plans have the alternative benefits provision and unfortunately many don't cover replacements of any kind. Unfortunately very few cover implants. Our experience has been that some companies will pay for the crown on an implant even if they don't pay for the implant, but at the reimbursement level for a crown on a tooth, which is a lot less costly than one on an implant.

Remember that insurance companies are in the business of making money and not spending it. They will use any means to get out of paying a claim if they can. How do you think they pay for those big office buildings?

Jerry

Jerry,
You know as well as I do that they make their profits by having our offices do half, if not more, of their administration.
I only want 1% of 1% of their net from the first month of the year. That's not greedy is it?

Thanks for the responses. I don't think my plan has the "Alternate Benefits Clause' but I will check.

Ok, we've heard from the doctors. How about the patients. Who paid for your implants? You or an insurance company?

Take care,
Eileen

Hi Eileen,
I had dental implants put in the bottom in May of 06, was supposed to have upper ones put in at the same time but woke up with no upper teeth but no implants either! The only thing that medical would pay for was the anesthesia to put me to sleep in the dentists office. Dental plan covered nothing, zero. Medical plan covered nothing to do with the actual implants, only with the anesthesia to remove the teeth. I paid close to $11,000 for the removal of my teeth and to have five implants placed in my bottom jaw. Then I paid $12,3000 for the bottom implant fixture (the teeth). I shouldn't say I paid that, actually a very wealthy friend of ours paid for it. My husband and I are middle class but he has some incredibly wealthy friends that are generous. So, don't go looking for insurance to cover it, I called every dental and medical plan in VA to find out if anyone covered it...........nope. Since the new cancer in August, I had to take the appliance off the bottom, now just have the implanted steel pins in my jaw but no bottom teeth. Depressing but I've grown used to it.

Good luck with it all,
Minnie

It's a nasty business because it falls into a crack between medical and dental coverage - and the insurance companies exploit that part of it...

Minnie,
When I had my 16 rear teeth extracted in the hospital prior to radiation, I did manage to get my medical insurance to cover the entire procedure as a medical expense required prior to radiation. This took letters of medical necessity from the dental surgeons and some argueing, but it did get covered. However, they refused to cover the partials to replace them as a medical expense.

I'm sorry to hear you can't use your bottom teeth. Is that only temporary or will that be a permanent condition? The year and a half that I only had my 12 front teeth was very diffcult in the eating dept. I felt like a rabbit. I can't imagine how hard it must be for you with no bottom teeth. Try not to let it get you down.

Take care,
Eileen

My cancer was at the top of my mouth and in my sinus so I have a hole in the top of my mouth to my sinus. My dr sent my to a prosthodontist and he made me a obturator which is a mouth piece that covers the hole and the next one will have teeth on it that they removed. This has all gone through my medical. So I would talk to your surgeon about it.

A bit late but I wanted to update all of you on my situation. I paid about $18,000 for porcelain veneer crowns made of gold and a couple of other metals that I don't remember August of 2007. I did half in August and half in September because the insurance year ended Aug 31. The dental insurance paid a whopping $854 but I tricked them because they had to pay twice, once for each plan year! Susan tenaciously challenged all the denials and they finally forked over another $4,000 on a medical claim about a year later. I still have about the same amount to pay to finish but I'm not sure when.

Ed

Hello all, I read in a SPOHNC newsletter about 2 years ago that Medicare was covering some dental damages caused by radiation. I can't find the article or anything about it anymore. Has anyone else seen or heard of this? Thanks, Carol

The last two people I fought for to get implants covered in Medicare were turned down. As most here know, I came out of the dental implant industry and designed and sold them worldwide through my company. They have never been covered even by dental insurance and were always private pay, (my wife is still a rep for Astratech, part of the giant pharma company Astra Zeneca, one of the world's largest implant manufacturer's and the reason I am able to donate my time to OCF instead of work at McDonald's for a living.)

The only people I have seen get Medicare covered implants are completely edentulous on the arch in question, and those are always mandibular arch reconstructions done with a pair of implants and a bar between them that a denture then snaps to. This is a nice restoration and very effective, though most people who are partially edentulous think of porcelain crowns on top of individual implants, which I have not seen covered no matter the cause for the tooth loss. Medicare in interested in restoring function only, which the two implants and over denture design does quite well, and will spend no money for things more.

Actually, since my original post, my company supplied dental insurance from Cigna now does cover dental implants. Since the max per year is $2400, it's not a lot when but every little bit counts.

Take care,
Eileen

Brian, thank you for the good news. My dentist has already discussed the ones you said medicare will cover. We are however, trying to save the 16 teeth I have left as long as we can. He seems to think that once I've passed the 6-7 year mark, I can get alot more done without using HBO. My radiation Dr says only one of the teeth will need HBO before being pulled. Have you ever heard of medicare covering the fillings, etc he's working on now? He wants to replace a bridge but so far we're keeping it. BTW I LOVE Laguna Niguel!

Hi Eileen, thanks. Although I'm on Medicare with a United Healthcare supplement that is nice to know. With the deluxe rider I bought, they only pay $500 a year. Not really worth the $39 a month.