I'm having a hard time getting my dental carriers that I already purchased out of pocket reimbursed. I submitted to medical and they denied saying it was a dental issue, so I sent it to Dental and they denied saying ask medical. I have a letter from the dentist indicating the importance of the device, you would think dental would cover it to prevent them from having to spend more money in the future on my dental bills!!!!
Did anyone have any luck with getting insurance to cover the trays? Was it medical or dental? Any advice would be great!
No. I went through the same circle you are going through. Ultimately they were denied by Dental because items like that were specifically excluded from my dental plan and they were denied by my medical because they are a dental apparatus. Basically, I gave up.
I don't have dental insurance so the medical insurance would not cover the fluoride trays even though they were medically necessary. My insurance did cover the prescription flouride gel though to put into the trays.
Charm
My trays were covered under my medical insurance.
They also covered the dental exams and panoramic dental x ray.
My Cancer Center is part a of a very large Medical complex that has a Dental group of Maxillofacial Prosthodontistsis and all OC patient have to go through that Dental group for pre Tx evaluation, tray fitting, interim and post Tx follow ups, so that might have made a difference from the insurance billing perspective.
Also, (FYI) I didn't need any dental work done.
Thanks everyone!
Don--I went to MD Anderson and also saw their dental people (no dental work needed either), I may try one more time to go through medical but I've pretty much think it will be a no go.
Just curious; what is the cost of a set a trays?
Mine were $400 in 1997 and no amount of arguing about medical necessity would convince either the medical or dental to cover them. My dental also will not cover fluoride treatments for anyone over 18. Good luck fighting this.
Take care,
Eileen
I hear ya Eileen, I guess its worth a try but I dont have high expectations.
Don- My trays cost $306.00.
We just picked up Mike's set of dental trays - cost: $230.00. That sounds pretty cheap compared to the responses above. I'm going to try claiming it against medical insurance as Mike hit the max for dental already for the year and it wouldn't cover it anyway but am not holding out much hope! All I could find in our medical plan was that they cover "limited" adjunctive care for dental but no specifics. If they don't cover it, I am hoping maybe they will apply it to our "catastrophic cap" total for the year.
John had/has no dental coverage and we spent a bundle on dental care needed prior to starting radiation--the dentist had the trays made gratis! I had no idea that the flimsy little things cost as much as what I'm seeing on here. Yikes! A lot less than the crowns and stuff, though.
Dental trays are primarily used for cosmetic purposes, such as teeth whitening so I haven't heard, yet, of any insurance co., dental or medical paying for them. Unfair - yes, but much of life is. Like John above my dentist made them for me gratis. Small reward for not referring me sooner to an ENT after my repeated requests of "What the hell is this large tan rubbery blob in my throat, pushing my uvula to the side?"...
They were 200 bucks (if I had to pay for them) at the time and they had to do a full mouth impression. They should be stored on the full mouth impression mold(s) to keep their shape. I still use mine 7 years post Tx. Your gums are going to take a beating from the radiation you will need them.
Look on the bright side - at least he has his teeth. Trays are very cheap insurance. You can write them off.
andys were $300. $150 down, and $150 when they came in. ins didnt cover them. good luck.
When my husband received his trays they were not covered on my medical or dental insurance. That was a cost that we had to pay out of pocket
Mine was covered by medical insurance (as it should be) as Cancer is a medical condition. Appeal the decision by the medical insurance company and copy the insurance commissioner of your state.
Chris, this is an old post, I doubt Elizabeth is able to go back 15 months to make an appeal. Please watch the dates when responding to posts and giving advice.
Ex.... I just had to move a post to put it where it was more relevant. The original post was a few years old. Sadly 3 of the members who commented on the thread have passed away. So please watch the dates, as not to upset any family members by giving advice to someone who is no longer with us. It hurts reading the words of my deceased friends!
Whatever happened to Brian's' plan to lock down down old posts . It's not only annoying but distressing when they resurrecting a three year old post from dead members we knew like another poster just did with Pete D. ( I complained about that one too) But since this post is still here, let me disagree
Gary is right here that most insurance companies will not and do not pay for flouride trays. If you read your contract, dental expenses like this are usually excluded from health benefit coverage even if they are now required as a consequence of having cancer.
Perhaps you might have some luck in California where the state is very active (gift cards that expire in the other 49 states don't expire there) in regulation but I know that the fluoride trays are not reimbursed under the Blue Cross/Blue Shield insurance plans.
[quote=ChristineB]Chris, this is an old post, I doubt Elizabeth is able to go back 15 months to make an appeal. Please watch the dates when responding to posts and giving advice.
Ex.... I just had to move a post to put it where it was more relevant. The original post was a few years old. Sadly 3 of the members who commented on the thread have passed away. So please watch the dates, as not to upset any family members by giving advice to someone who is no longer with us. It hurts reading the words of my deceased friends! [/quote]
Sorry. I didn't even notice the date. I'm still fairly new here.
Have a good weekend,
Chris
I think Fluoride trays are critical for many folks who are having RT, and they can be the difference between saving teeth vs not, since Radiation caries can be rampant.
I agree with trying to have medical insurance pay for them, since they are primarily for dealing with effects of Tx from RT
Sameh
Welcome to OCF. Well said. Your profile says you are a dentist. Has it been your experience that your patients can get reimbursed by their insurance? My impression was that most posters had difficulty or total refusal by their insurance company to pay for the trays. It was so strange to have my insurance deny payment claiming I don't have the optional federal dental insurance, but still pay every month for the prescription flouride gel.
No body disagrees with trying, but the question is whether the effort is futile or fruitful. As a dentist you would be a good position to share with us your experiences with whether insurance pays for the flouride trays you make for your patients.
Charm
WOW! So much time has past since this post and I never got reimbursed!!LOL I tried and tried but gave up. In my case the effort was futile but if you don't ask and try you will never know.
Elisabeth
You are so right that you have to at least try. I know I feel better having appealed my insurance denial up thru two levels at OPM. It turned out just like Gary posted. Still it sucks and is patently unfair to us oral cancer patients.
Charm
Question: Is the water fluoridated in the US? No one has said a word about fluoride trays to Alex and I here and I figured it would be a battle I could have with Alex in the future as he will not countenence any more "treatment" right now. It occurs to me that the reason no one has suggested it is because our water has fluoride added and maybe the US water doesn't???
Karen
Per Wikipedia.....A 1992 census found that, for U.S. public water supply systems reporting the type of compound used, 63% of the population received water fluoridated with fluorosilicic acid, 28% with sodium fluorosilicate, and 9% with sodium fluoride.
I know the above figures are not correct since it does not account for houses that use wells. The house I used to live in had well water as did everyone else within a 10 mile radius. When I attempt to find out how many households depend on wells I get several different figures, up to 10% of the population.
We haver lurked in our water here in Canada and I was still told to get flouride trays - I would ask - it's important - your don't want to have to have a tooth pulled post radiation if you can avoid it.
The fluoridated water isn't enough to really protect your teeth. My surgeon and prosthodontist said the fluoride trays were a must, and for the rest of my life (it's not that big a deal to do daily). This all to prevent tooth decay and, as Cheryl says, to prevent your ever needing to have a tooth pulled post radiation.
Karen
We definitely have lots of flouride in our Washington DC area water (along with an array of other chemicals) but my prosthodontist said the same thing: it's not enough flouride and not concentrated on the teeth and that flouride trays are the way to go.
If you do go that way, I recommend being sure to get a "gel" with a narrow nozzle and not a toothpaste type flouride - there was an interesting discussion here a while ago about using a syringe to make the toothpaste cream type work, but I find it easier to just buy the type that works right out of the little tube it come in.
Last but not least, while my insurance refused to pay for the flouride trays, they continue to pay for two full tubes of the prescription flouride each and every month with no quibble.
Charm
Sometimes the problem with getting these things covered has to do with the coding. Make sure the coding done in the dentist office is correct for cancer and not cosmetic. Don't know if it helps. We just had dental deny, turfing it to medical. I'm going to confirm coding with our dentist and then I'm going to medical next. On one hand, I can't complain as our insurance has covered almost everything. On the other hand - I pay dearly for 2 insurance policies and it is a necessity for head and neck radiation.
Donna - RN, BSN, COS-C